JNEBRIETY 

A  Clinical  Treatise  on  the  Etiology, 
Symptomology,  Neurosis,  Psy- 
chosis and  Treatment 


MEDICO-LEGAL  RELATIONS 


BY 

T.  D.  CROTHERS,  M.  D. 

Supt.  Walnut  Lodge  Hospital,  Hartford,  Conn. 

Editor  of  the  Journal  of  Inebriety,  Author  of  Morphinism,  and 
Narcomania,  Drue  Habits  and  their  Treatment,  etc..  Record- 
ing Secretary  of  the  American  Medical  Society  for  the 
Study  of   Alcohol    and   Other   Narcotics,  Member 
of   the   American    Medical   Association,   The 
British    Medical  Association,  Honorable 
Member  of  the   British   Society  for 
the  Study  of  Inebriety,  etc.,  etc. 


1911 

HARVEY  PUBLISHING  COMPANY 

CINCINNATI,  OHIO 


u 


COPYBIGHT,  1911 
BY 

HABVKT  PUBLISHING  Co. 


DEDICATED 

To    THE    MEMORY   OF    THE    GREAT    PIONEER   PROPHET, 
STUDENT  AND  TEACHER  OF  INEBRIETY  AS  A  DISEASE, 

DR.  JOSEPH  EDWARD  TURNER, 

who  was  born  in  Bath,  Maine,  October  5,  1822.  He  was 
the  promoter,  founder  and  superintendent  of  the  first 
inebriate  asylum  in  the  world  for  the  medical  care  and 
treatment  of  inebriates,  opened  at  Binghamton,  New  York, 
in  1864. 

For  over  forty-five  years  he  urged  that  inebriety  was 
a  disease  and  should  be  studied  and  treated  the  same  as 
any  other  malady,  and  that  the  inebriate  was  curable  by 
scientific  means  and  measures  in  special  surroundings. 

These  facts  were  maintained  with  heroic  persistency  and 
pressed  with  martyr-like  courage,  in  season  and  out  of 
season.  He  was  opposed,  condemned  and  finally  driven 
out  of  the  institution  of  his  own  creation,  and  persecuted 
as  a  charlatan  up  to  the  time  of  his  death,  July  4,  1889. 

This  volume  is  offered  as  a  slight  recognition  and 
tribute  to  the  man  and  his  work,  who  was  literally  a  dis- 
coverer of  a  new  realm  of  scientific  medicine. 


26427 


PREFACE. 

The  alcoholic  question  is  positively  one  of  the  greatest 
medical  and  social  science  problems  confronting  the  civiliza- 
tion of  to-day.  This  is  clearly  evident  from  the  wide- 
spread efforts  and  activities  of  societies,  churches,  political 
parties,  humanitarians,  philanthropists  and  scientists  to 
overthrow  or  control  the  evils  from  this  source;  and 
from  the  intense  interest  in  the  various  efforts,  ways  and 
means  of  prevention  and  cure. 

Every  sociological  and  scientific  study  of  degeneration 
and  disease  reveals  the  magnitude  of  the  alcoholic  influence, 
and  its  intimate  relations  to  individuals  and  society,  and 
its  destructive  effects  on  the  social,  hygienic  and  physio- 
logical development  of  the  race. 

Inebriety  was  regarded  as  a  disease  centuries  ago,  long 
before  insanity  was  thought  to  be  other  than  a  moral  dis- 
order, and  yet  the  studies  and  literature  up  to  recent  times 
have  reversed  this.  Inebriety  is  considered  a  voluntary 
vice  and  moral  evil,  and  insanity  a  disease. 

Notwithstanding  the  advances  of  scientific  medicine  and 
the  studies  of  mental  disease,  the  theories  of  moral  causa- 
tion and  moral  remedies  still  occupy  a  prominent  place  in 
the  discussions  of  inebriety. 

The  purpose  of  this  volume  is  to  group  and  study  the 
phenomena  of  inebriety  and  its  varied  symptomology  from 
the  scientific  point  of  view,  and  show  that  the  teachings 
of  ages  ago  are  sustained  by  modern  research,  and  that 
inebriety  is  not  a  moral  disorder,  but  a  distinct  neurosis 
and  psychosis,  preventable  and  curable  by  the  use  of 

physical  and  psychical  means  and  measures. 

5 


6  PREFACE. 

As  in  other  scientific  work,  the  studies  must  begin  with 
a  knowledge  of  the  causes  and  the  conditions  which  follow 
and  precede  inebriety  and  are  dependent  on  them,  and 
from  this  data  to  trace  some  uniform  law  of  origin, 
growth  and  development. 

Statistical  data  with  tables  and  charts  are  omitted, 
because  their  conclusions  are  variable  and  open  to  sources 
of  error,  and  of  necessity  more  or  less  transient  and  uncer- 
tain. Experience  has  shown  that  a  clinical  description  of 
cases  and  studies  of  the  surroundings  and  conditions 
suggest  a  great  variety  of  exciting  and  predisposing 
causes  that,  furnish  a  wealth  of  facts  for  farther  and 
more  exact  work. 

The  studies  and  conclusions  embodied  in  this  volume 
are  the  result  of  a  practical  experience  beginning  in  1875 
as  Assistant  Physician  in  the  New  York  State  Inebriate 
Asylum,  at  Binghamton,  New  York,  and  extending  from 
1878  up  to  the  present  time  as  Superintendent  of  Walnut 
Lodge  Hospital,  Hartford,  Conn.  In  addition  to  this, 
the  work  as  editor  of  The  Journal  of  Inebriety,  which 
was  first  published  in  1876,  has  furnished  a  somewhat 
intimate  acquaintance  with  the  scientific  literature  on  this 
subject,  both  in  this  country  and  Europe. 

From  this  experience  with  its  accumulated  data  of 
history  of  cases,  an  effort  is  made  to  arrange  and  compare 
a  great  variety  of  facts  and  their  relation  to  each  other, 
and  trace  some  of  the  laws  which  evidently  control  their 
movements,  confirming  the  conclusion  that  inebriety  is  a 
disease  both  preventable  and  curable  from  a  larger  knowl- 
edge and  the  use  of  more  exact  scientific  means  and  meas- 
ures. 

The  medico-legal  relations  which  center  about  the 
inebriate  and  his  conduct  have  developed  many  very 
startling  questions  of  responsibility  that  are  coming  into 
increasing  prominence. 


PREFACE.  7 

The  chapters  in  this  book  give  an  outline  of  the  con- 
fused theories  and  teachings  concerning  the  practical 
relations  of  crime  and  the  responsibility  of  the  inebriate. 
The  importance  of  this  subject  is  merely  indicated  in  this 
work,  with  the  hope  that  in  the  near  future  a  more 
extended  study  will  be  given  in  a  separate  volume  on  the 
practical  relations  of  inebriety  and  crime  and  their  medico- 
legal  considerations. 

One  of  the  prominent  conclusions  which  the  evidence  in 
this  work  sustains  is  that  inebriety  is  a  disease  and  its 
phenomena  are  controlled  by  uniform  laws,  which  move 
with  exactness  and  certainty  along  lines  of  origin,  develop- 
ment, decline  and  extinction ;  also  that  it  is  possible  from 
a  larger  knowledge  and  study  of  these  causes  to  prevent, 
cure  and  stamp  out  this  neurosis  with  the  same  certainty 
as  in  germ  diseases. 

The  physiological  and  chemical  action  of  alcohol  on  the 
brain  and  nervous  system  has  been  the  subject  of  many 
exhaustive  studies,  and  the  impression  has  been  encouraged 
that  alcohol  is  the  specific  and  only  cause  of  inebriety. 
This,  a  clinical  examination  of  the  history  of  cases,  fails 
to  confirm,  but  indicates  that  the  use  of  alcohol  is  very 
often  a  symptom  of  disease  and  later  it  becomes  an  active 
cause,  hence  a  specific  study  of  this  drug  gives  only  a 
limited  view  of  the  great  factors  and  causative  agents  of 
inebriety. 

This  work  is  practically  a  continuation  and  more 
advanced  study  of  the  subject  so  admirably  begun  by  the 
late  Dr.  Norman  Kerr,  of  London,  England,  in  his  work 
on  "Inebriety  and  Narcomania,"  which  passed  through 
several  editions  and  is  still  being  sold.  It  is  also 
intended  to  make  prominent  the  conclusions  from  scientific 
studies,  that  the  entire  problem  is  one  of  scientific,  curative 
and  preventive  medicine,  which  the  trained  physician  is 
most  competent  to  study  and  understand.  Hence,  it  is  a 


8  PREFACE. 

medical  topic  in  which  medical  men  should  be  students, 
teachers  and  authorities  in  the  efforts  of  cure  and  pre- 
vention. 

As  an  outline  view  of  a  great  new  continent  in  which 
the  facts  presented  stand  like  mountain  peaks,  leaving 
wide  stretches  of  undiscovered  country,  this  book  is  offered 
for  the  distinct  purpose  of  creating  new  interest  in  a 
wider  and  more  exact  study  of  the  neurosis  and  psychosis 
which  are  called  inebriety  and  alcoholism. 

T.  D.  CEOTHEES,  M.  D. 
HAETFOED,  CONN.,  Jan.   1911. 


TABLE   OF   CONTENTS. 


CHAPTEB.  PAGE. 

I.     Inebriety  as  Noted  in  Modern  Civilization 13 

II.     The  Recognition  of  Inebriety  as  a  Disease 22 

III.  Efforts  to  Study  Inebriety  from  a  Scientific  Point  of 

View 29 

IV.  Forms  of  Classifications  of  Inebriety 39 

V.     Inebriety  in  America  and  its  Peculiarities 46 

VI.  General  Symptomology  and  Development 55 

VII.  Peculiarities   of    Conduct   and    Thought   Traceable   to 

Inebriety 61 

VIII.  Periodic  Inebriety  and  its  Symptomology 70 

IX.  Continuous  Drinkers   85 

X.  Inebriety  in  the  Form  of  Moral  Insanity 93 

XI.  General  Causes  and  Favoring  Conditions 105 

XII.  Special   Causes  of  Inebriety 117 

XIII.  Injuries  and  Psychosis  which  Follow  from  the  Toxic 

Use  of   Spirits 128 

XIV.  Heredity  and  its  Influence   in  the  Causation  of   Ine- 

briety   140 

XV.     Some    of    the    Neuroses    Following    the    Inebriety    of 

Parents 148 

XVI.  Psychic  Phenomena  of  Inebriety  Traceable  to  Heredity.158 

XVII.  Pathology  of  Inebriety 176 

XVIII.  Diagnosis   of   Inebriety 186 

XIX.  Prognosis  of   Inebriety 195 

XX.  Delirium   Tremens    203 

XXI.  First  Clinical  Examination  and  Study  of  the  Patient.  .217 

XXII.  General  Principles  of  Treatment 223 

XXIII.  Home  and  Office  Treatment  of  Inebriates 231 

XXIV.  Institutional  Treatment  of   Inebriates 249 

XXV.     State  Care  and  Treatment  of  Inebriates 261 

9 


10 


CONTENTS. 


CHAPTER.  PAGE. 

XXVI.     Treatment  by  Hot  Air,  Radiant  Light  Baths,  Vibra- 
tion and  Electric  Currents 272 

XXVII.     Mental  Therapeutics  and  Suggestion  in  the  Treatment 

of  Inebriety 286 

XXVIII.     History  of  the  Empiricism  Connected  with  Inebriety.  .298 
XXIX.    Criminal  Inebriates  and  Medico-Legal  Superstitions . . .  305 
XXX.     Forms  of  Irresponsibility,  Alcoholic  Amnesia,  Claims 

of   Prisoners,   etc 317 

XXXI.     Medico-Legal  Questions   of  Inebriety 329 

XXXII.     Premeditation   in   Criminal   Inebriates 338 

XXXIII.     Diseases  and  Neuroses  Associated  with  Inebriety 345 

Index  .  ..359 


CHAPTER   L 

INEBRIETY  AS  NOTED  IN  ANCIENT  CIVILIZATION. 

Synopsis. —  Subject  discussed  eight  thousand  years  ago.  Arch- 
aeological researches  of  Egyptian  Tombs,  show  that  inebriety  was 
a  disease  in  that  early  day.  Papyri  found  in  the  tombs  describe 
the  disease  and  its  remedy.  How  these  records  were  preserved. 
The  same  strains  and  unrest  produced  inebriety.  Egypt  a  land 
of  banqueting  and  wine  and  beer  as  votive  gifts  to  the  gods. 
Great  quantities  of  wine  used  at  religious  feasts.  People  be- 
came drunk.  Efforts  to  restore  them.  Beer  made  at  a  town 
called  Quede.  For  centuries  this  was  the  great  beer  producing 
town.  Complaints  of  writers  about  the  dissipation  of  the  people. 
Method  of  making  wine  and  the  suppression  of  the  vineyards  by 
a  royal  edict.  Instance  of  a  great  battle.  Sett'.ed  by  the  use  of 
wine.  Priests  medical  men  at  that  period.  Led  in  the  efforts  to 
reform.  Theories  of  the  effects  of  spirits  and  suicides.  Reigning 
monarchs  become  total  abstainers.  Sale  of  wine  and  beer  pro- 
hibited. Restrictions  concerning  intoxicated  persons.  Poor  peo- 
ple made  slaves  for  excessive  drinking.  Rich  people  had  their 
property  confiscated  from  drinking  to  excess.  Edicts  that  no 
spirits  should  be  used  at  times  of  war.  Mummies  have  Papyri 
about  them  showing  that  they  died  from  the  use  of  liquor.  First 
specialist  who  treated  inebriety  as  a  disease.  First  homes  where 
people  were  confined  for  medical  treatment.  Inscriptions  on  the 
walls  of  the  tombs  show  methods  of  treatment.  The  use  of  water, 
purg-at.ives,  also  the  use  of  opium  and  salts  were  prominent 
remedies.  Women  drinking  to  intoxication  noted.  Pictures  of 
scenes.  Researches  in  Babylon  show  similar  struggles  to  overcome 
the  use  of  spirits.  Cuneiform  inscriptions  on  bricks  dug  up  at 
Neppo.  Capitol  punishment  as  a  remedy.  Secret  remedies  used. 
Incidents  and  stories. 

There  is  something  startling  in  the  fact  that  the  al- 
coholic problem  was  a  subject  of  intense  interest  and 
discussion  at  least  eight  thousand  years  ago.  The  re- 
searches of  the  various  archaeological  societies,  particu- 
larly in  Egypt,  among  the  long  buried  records  in  pyra- 
mids and  tombs,  the  pictures  on  the  walls  and  the  writings 
on  papyri,  enclosed  in  the  sarcophagi,  show  that  the 
di.sca.se  of  inebriety  Avas  recognized,  and  the  means  of  cure 
and  prevention  studied  at  least  five  thousand  years  before 
the  Christian  era. 

The  religion  of  that  ancient  civilization  decreed  that 
the  preservation  of  the  body  was  necessary  in  order  that 

13 


14  INEBRIETY. 

the  soul,  when  it  returned,  in  the  long  ages  to  come, 
should  have  the  same  tabernacle  to  take  possession  of, 
that  it  had  vacated  at  death.  For  this  purpose  the  body 
was  embalmed,  pyramids  were  built,  and  temples  and 
tombs  were  erected  to  contain  the  body ;  records  and  in- 
scriptions, papyrus  rolls  were  inscribed,  containing  the 
history  of  events  of  the  lives  of  the  dead;  the  political 
achievements  of  individuals,  and  the  religious  thought  and 
endeavors  of  sages,  thinkers,  law-makers,  kings  and  war- 
riors of  that  time. 

The  climate  of  Egypt,  its  warm,  dry,  drifting  sands, 
moving  with  every  breath  of  wind,  made  the  country 
peculiarly  fitted  to  become  a  vast  Valhalla  of  imperish- 
able records.  At  this  day  miles  and  miles  of  tombs, 
buried  deep  in  the  hot  sand  for  long  centuries,  are  yet 
uncovered.  In  the  records  found  of  the  great  events  oc- 
curring in  the  reigns  of  long  lines  of  Pharaohs,  we  read 
of  the  reforms  which  they  promoted,  the  edicts  they  pro- 
mulgated and  note  that  the  life  in  those  far  off  days  was 
as  full  of  excitement  and  unrest  as  ours  at  the  present. 
The  same  strain  and  stress  seemed  to  culminate  in  the 
same  mental  and  physical  exhaustion,  and  desire  for  rest, 
which  characterizes  our  modern  civilization. 

Egypt  was  a  land  of  banqueting,  the  celebration  of 
feast  days,  religious  rites,  and  sacrifices  were  frequent 
and  wine  and  beer  were  the  votive  gifts  made  to  the 
gods.  These,  with  great  quantities  of  provisions,  were 
brought  to  the  temple  on  feast  days,  and  laid  on  the 
altars.  It  was  supposed  that  the  spirits  of  the  departed 
ones  came  back  and  partook  of  the  spirits  of  these  foods, 
after  which  the  remainder  was  distributed  to  the  priests 
and  temple  worshipers.  Pliny  the  Elder  tells  us  that  on 
one  occasion  ten  thousand  jugs  of  beer  and  five  thousand 
vessels  of  wine  were  offered  to  the  gods.  On  another  ac- 
casion  the  king  donated  the  product  of  five  hundred  vine- 


INEBRIETY  AS  NOTED  IN  ANCIENT  CIVILIZATION.     16 

yards  as  a  special  offering.  On  the  tomb  of  another  king, 
among  his  great  virtues,  is  mentioned  the  fact  that,  dur- 
ing his  reign,  he  gave  for  sacrificial  purposes  an  offering 
of  two  hundred  thousand  jars  of  wine  and  half  a  million 
jugs  of  beer.  After  all  services,  the  foods  were  eaten 
and  the  liquor  was  drunk  by  the  worshipers,  and  at 
Memphis  a  temple  was  provided  with  chambers  where 
these  offerings  could  be  consumed. 

They  were  practically  religious  banquets,  and  were 
finally  suppressed  for  the  reason  that  they  were  consid- 
ered injurious  to  the  peace  and  good  order  of  society, 
and  also  because  they  afforded  opportunities  for  plots  and 
intrigues  against  the  government.  Another  reason  was 
given  that  both  priests  and  worshipers  were  made  stupid 
from  drink,  and  often  had  to  be  taken  home  by  the  slaves, 
or  to  the  banks  of  the  river  and  left  there  to  become  sober. 
In  their  stupid  condition  they  were  often  robbed  by 
thieves,  and  then  they  made  complaints  to  the  courts  of 
the  wrongs  they  had  suffered.  We  can  believe,  in  the 
absence  of  any  direct  information,  that  those  far-off 
judges  repeated  the  same  dictum  with  equal  solemnity 
that  we  hear  in  our  modern  courts,  that  "drunkenness  is 
no  excuse  for  crime,  or  the  suffering  and  losses  which  fol- 
low." 

A  town  called  Quede  seems  to  have  had  the  monopoly 
and  the  reputation  of  producing  the  finest  beer,  and  for 
several  centuries  it  was  the  "Milwaukee"  of  that  country, 
and  is  mentioned  frequently. 

Wine  was  the  favorite  drink  of  the  people,  and  on 
some  of  the  tombs  built  at  least  five  thousand  years  before 
the  Christian  era,  there  are  descriptions  of  the  method  of 
manufacture,  and  the  different  kind  of  wine  used.  Many 
pictures  show  the  process  of  extracting  the  juice  of  the 
grape,  and  the  various  methods  of  planting  and  cultivat- 
ing vineyards.  One  writer  complains  of  adulteration 


16  INEBEIKTY. 

which  caused  much  stupor  in  the  drinker.  Palm-tree  wine 
was  condemned  because  of  its  rapid  intoxicating  qualities, 
and  beer  was  thought  injurious,  because  it  bloated  its 
victims.  Large  vases  of  wine  were  sealed  up  and  placed 
in  the  tombs  of  the  wealthy  to  give  nourishment  to  the 
soul,  when  it  came  back  to  look  after  the  body ;  these  wine 
jars  are  found  just  as  they  were  placed.  The  wine,  of 
course,  long  ago  disappeared,  but  many  of  the  jars  are 
covered  with  descriptions  of  the  manufacture  of  the  wines 
and  the  culture  of  the  grapes,  as  well  as  other  general 
events  of  the  time. 

One  of  these  vases,  now  in  the  British  museum,  found 
in  the  tomb  of  a  monarch,  who  lived  over  six  thousand 
years  ago,  contains  the  statement  that  the  wine  was  made 
from  white  grapes,  and  that  the  king  had  suppressed  the 
culture  of  this  kind  of  grapes,  save  only  in  the  royal  vine- 
yards. It  is  stated  that  drinking  this  kind  of  wine  is 
never  followed  by  evil  results.  On  another  vase  is  a  story 
of  a  great  battle  between  the  kings  of  upper  and  lower 
Egypt,  during  which  beer  from  seven  thousand  jugs, 
mixed  with  the  blood  of  prisoners  and  slaves,  was  left  on 
the  field  by  one  retreating  king.  The  enemy  follov.ing, 
stopped,  and  drank  the  beer,  and  as  a  result  became  intox- 
icated and  were  easily  destroyed. 

While  both  beer  and  wine  were  used  to  propitiate  the 
gods,  as  offerings  to  them,  their  injurious  effects  were 
recognized,  and  many  efforts  were  made  to  suppress  or 
limit  their  use  among  the  common  people.  The  priests, 
who  were  the  medical  men  of  that  period,  seem  to  have  led 
in  the  efforts  for  reform.  On  the  tomb  of  one  of  them  is 
a  prediction  that  if  wines  and  beers  continued  to  be 
used  by  all  classes,  the  nation  would  be  doomed  to  destruc- 
tion, and  deserted  by  the  gods.  Another  tomb  contains 
an  equally  ominous  prediction,  and  declares  that  a  small 
quantity  of  wine  and  beer  will  clarify  the  soul,  and  give 


INEBRIETY  AS  NOTED  IN  ANCIENT  CIVILIZATION.     17 

it  greater  power  in  the  other  world,  but  if  large  quan- 
tities are  used,  it  will  stupify  and  chill  the  soul,  and  keep 
it  in  a  place  of  torment.  On  a  third  tomb  the  theory  of 
reincarnation  is  outlined,  and  the  cause  of  excessive 
drunkenness  in  some  men  is  said  to  be  the  possession  of 
the  spirits  of  loathsome  animals.  Another  statement  de- 
clares that  the  victim  of  the  excessive  use  of  liquor,  who 
becomes  stupid,  falls  down  and  breaks  his  head,  liberates 
the  spirit  from  the  body  before  the  gods  want  it,  and 
hence  is  doomed  to  a  long  period  of  punishment. 

From  the  very  earliest  records,  mention  is  made  of  dif- 
ferent efforts  to  suppress  the  excessive  use  of  spirits. 
When  the  reigning  monarch  was  a  total  abstainer,  strenu- 
ous laws  were  passed  forbidding  the  use  of  wine,  except 
on  special  occasions,  but  when  the  monarch  himself  was  a 
drinker,  there  were  few  if  any  restrictions. 

Some  of  the  legal  enactments  to  suppress  the  use  of 
alcohol  and  punish  the  inebriate,  have  a  very  modern 
sound.  At  one  period,  the  sale  of  wine  and  beer  was  pro- 
hibited, except  in  shops  on  side-streets,  away  from  public 
observation ;  and  the  dealer  paid  a  tax  for  the  privilege 
of  selling,  and  was  forced  to  provide  clean  rooms,  with 
places  for  persons  who  became  intoxicated ;  or  he  had  to 
take  them  home  at  his  own  expense,  particularly  after 
night-fall.  Poor  people  who  drank  and  were  boisterous 
were  fined  heavily,  and  often  made  slaves  to  the  govern- 
ment until  the  fines  were  paid.  Rich  people  who  became 
inebriates  had  their  property  confiscated,  particularly  if 
they  persisted  in  drinking  to  excess  in  public,  making 
themselves  disagreeable  to  others. 

One  king  boasted  that  he  never  lost  a  battle  when  he 
prevented  his  soldiers  from  having  wine  or  beer  before  the 
engagement.  Another  statement  is  made  that  bread  and 
water  are  the  most  powerful  stimulants  to  give  soldiers 
strength  and  courage  on  the  march.  The  incident  is 


18  INEBRIETY. 

mentioned,  that  after  a  victorious  battle,  the  king  and 
his  army  made  a  great  drink  offering  to  the  gods.  In 
the  midst  of  their  drunken  joy  and  stupor,  the  enemy  re- 
turned and  frightful  slaughter  followed.  Later,  an  edict 
was  made,  that  no  wines  or  beers  should  be  given  in  the 
campaign,  and  no  vinous  offerings  to  the  gods  should  be 
used,  until  the  troops  had  returned  home.  Wines  and 
beers  were  kept  in  the  homes  of  the  wealthy,  in  rooms 
built  for  the  purpose,  where  they  could  be  used  in  secrecy ; 
and  on  some  of  the  mummies  are  papyri  indicating  that 
death  was  due  to  the  use  of  liquor. 

In  one  of  the  tombs  there  is  the  statement  that  the 
occupant,  a  priest,  was  skilled  in  the  treatment  of  mad- 
ness following  the  use  of  wine.  He  was,  no  doubt,  one  of 
the  first  specialists  to  treat  inebriety  and  the  drink  disease. 
On  another  tomb  is  the  statement  that  the  deceased  had 
built  a  house,  where  persons  who  were  made  mad  from 
wine  and  beer  were  received.  This  was  probably  the 
first  inebriate  asylum,  and  dates  back  five  thousand  years 
before  the  Christian  era. 

Another  mummy  was  evidently  in  life  a  favorite  priest 
in  the  family  of  a  drinking  king,  and  the  inscription  de- 
scribes his  skill  and  success  in  his  efforts  to  keep  the 
monarch  from  drink  madness.  Numerous  pictures  and 
inscriptions  on  the  walls  of  the  tombs  refer  to  the  treat- 
ment of  the  drink  excess,  which  seems  to  be  confined 
largely  to  sobering  the  victims.  These  pictures  show  in- 
toxicated persons,  brought  home  by  their  slaves  from  the 
temple  or  banqueting  halls ;  the  efforts  made  to  force 
fluids  into  the  stomach  through  funnels,  with  resultant 
vomiting;  and  the  giving  of  enemas,  following  by  purg- 
ing. 

In  many  instances,  streams  of  water  were  poured  on  the 
heads  and  backs  of  intoxicated  persons,  while  rubbing, 
kneading,  flagellation,  and  pressing  the  body,  were  means 


INEBRIETY  AS  NOTED  IN  ANCIENT  CIVILIZATION.     19 

used  to  remove  the  effects  of  the  drink  excess.  Another 
picture  shows  a  man  covered  with  a  robe,  from  the  open- 
ings in  the  folds,  vapor  is  escaping,  indicating  a  steam 
bath,  made  by  putting  hot  stones  in  water.  Some  of  the 
papyri  give  accounts  of  the  use  of  opium  and  salts  as 
remedies.  One  contains  the  description  of  an  injury  on 
the  head,  which  made  the  victim  drink  madly.  Another 
speaks  of  the  action  of  the  sun  taking  away  all  power  of 
self-control,  and  leaving  the  victim  a  drunkard.  All  these 
suggest  physical  causes. 

Women  appear  to  have  drunk  as  freely  as  men.  Some 
of  the  pictures  show  banqueting  halls  in  which  women 
were  clearly  intoxicated.  The  head-dress  and  robes, 
falling  from  the  shoulders,  show  that  they  were  both 
hilarious  and  stupid.  Later  they  are  vomiting  and  being 
carried  out  by  attendants. 

Researches  in  the  ruins  and  temples  of  Babylon  give 
distinct  intimations  of  similar  battlings  with  alcohol,  dur- 
ing the  civilizations  that  flourished  in  the  cities  of  the 
Euphrates  and  Tigris  valleys.  Grapes  were  cultivated 
and  wine  was  the  common  drink.  The  cuneiform  inscrip- 
tions on  the  bricks  dug  up  by  Neppo,  tell  the  same  story 
of  drunkenness  and  of  the  efforts  to  correct  it.  About 
the  same  remedies  and  means  were  used  to  make  the  vic- 
tim sober,  as  were  used  in  Egypt,  and  some  of  the  bricks 
contain  bills  of  charges  for  services  rendered  on  such  oc- 
casions. Dashing  cold  water  over  the  victim  and  whip- 
ping him  with  brushes  were  the  common  remedies. 

One  king  appeared  to  have  made  an  offer  of  great  pre- 
ferment with  large  sums  of  money  to  the  courtiers  who 
would  abstain  from  liquor.  A  certain  prince  once  took 
the  prize  and  soon  after  became  intoxicated.  The  king 
ordered  his  instant  death,  and  gave  his  opinion  that  such 
a  man  was  unfit  to  live.  On  one  of  the  bricks  is  a  state- 
ment that  has  a  very  familiar  and  modern  sound.  It 


20  INEBRIETY. 

records  the  fact  that  a  certain  priest  had  discovered  a 
medicine  for  drink  madness  which  he  would  sell  to  any  one 
for  a  certain  sum  of  money.  On  another  brick  it  is  said, 
that  a  priest  had  given  a  certain  monarch  a  drug,  which 
prevented  him  from  becoming  intoxicated,  and  yet  en- 
abled him  to  drink  freely.  In  both  of  these  instances  the 
inference  is  that  these  specific  drugs  were  secrets,  and 
were  only  sold  to  those  who  could  pay  for  them. 

The  specific  discoveries  of  modern  times  are  antedated 
by  several  thousand  years,  and  probably  further  re- 
searches may  tell  us  more  of  the  wonderful  remedies  used 
in  those  old  days.  There  were  saloons  and  wine  shops  in 
ancient  Babylon,  and  men  who  drank  to  excess  were  pun- 
ished by  whipping  or  enslavement.  Although  these 
records  are  fragmentary  and  broken,  they  give  abundant 
evidence  that  inebriety  as  a  disease  attracted  attention 
and  was  a  vital  study,  and  that  many  of  the  physical 
causes  were  understood.  No  doubt  further  researches 
will  supplement  this  evidence. 

Our  struggles  with  the  alcoholic  evil,  our  methods  of 
license  and  prohibition,  are  mere  repetitions  of  the  earlier 
attempts  made  in  the  dawning  of  civilization  to  deal  with 
the  self-same  curse.  Many  of  the  early  Grecian  writers 
on  this  subject  made  reference  to  ancient  Egyptian  lit- 
erature. One  of  these  references  is  given  by  Theo- 
phrastus,  a  Grecian  philosopher,  describing  the  sickness 
caused  by  wine,  and  the  medicine  used  to  cure  it.  This 
was  taken  from  an  old  papyrus,  and  is  stated  as  we  would 
at  present  give  the  history  of  a  clinical  case  illustrating 
some  fact  or  theory.  The  following  is  a  rough  transla- 
tion. The  wife  of  a  certain  king  in  Egypt,  having  drunk 
a  large  quantity  of  Cretan  wine,  became  immoderately 
mad,  and  strangely  affectionate,  embracing  and  kissing 
every  man  she  met ;  from  laughing  and  singing  she  be- 
came angry  and  quarrelsome  and  wanted  to  strike  every- 


INEBRIETY  AS  NOTED  IN  ANCIENT  CIVILIZATION.     21 

body.  She  was  violent  and  suspicious  of  everything; 
everybody  in  the  house  was  frightened,  and  took  great 
precautions  to  avoid  coming  in  contact  with  her.  Then 
sorrowful  and  lamenting,  she  prayed  to  her  dead  relatives 
and  friends  in  plaintive  songs.  She  was  then  overcome 
by  sleep,  during  which  she  snored  loudly.  On  awakening, 
spirits  of  antimony  were  given,  and  water  poured  over 
her  head  and  body,  followed  by  inunctions  of  oil,  after 
which  she  recovered.  This  very  clear  description  of  an 
attack  of  acute  intoxication  was  no  doubt  made  the  text 
for  an  elaborate  thesis,  which  is  lost. 

Galen,  one  of  the  early  Grecian  physicians,  describes 
some  remedies  for  the  disease  which  follows  the  use  of 
wine.  He  divides  the  remedies  into  two  classes,  and  does 
not  state  what  they  are,  but  gives  a  theory  of  their  action 
in  some  detail.  The  first  remedies  were  to  be  used  before 
the  wine,  the  object  of  which  was  to  prevent  its  fumes 
from  rising  upward  and  affecting  the  brain.  The  second 
remedy  was  to  be  used  after  the  stupor  and  debauch,  to 
drive  out  the  fumes  of  wine  by  the  bowels  and  kidneys. 
These  and  other  very  quaint  references  show  that  the 
treatment  of  inebriety  was  very  seriously  considered  in 
those  early  days. 


CHAPTER   II. 

THE  RECOGNITION  OF  INEBRIETY  AS  A  DISEASE. 

Synopglg. —  Herodotus  wrote  of  inebriety,  calling  it  a  "Drink 
Madness."  Many  philosophers  insisted  that  inebriety  was  inher- 
ited and  laws  were  passed  forbidding  women  and  boys  to  use 
wine.  Severe  restrictions  enforced  to  produce  total  abstinence. 
Inebriety  likened  to  dyspepsia  in  the  first  century  of  the  Christian 
Era.  Ulpian  a  Roman  Jurist  commented  on  the  disease  and  its 
legal  remedies.  Laws  were  passed  providing  that  murders  com- 
mitted during  intoxication  should  be  remitted  because  of  disease. 
Drunkenness  and  Madness  considered  synonymous.  Condillac's 
views.  Dr.  Hush's  teaching's.  Cabanis'  book  on  Inebriety.  Sal- 
vator's  work  on  Inebriety,  its  Pathology  and  Treatment.  Other 
authors  who  wrote  freely  on  this  subject.  Dr.  Todd's  lecture  on 
The  Need  of  Inebriate  Asylums.  The  literature  on  this  subject 
and  its  cold  reception.  The  English  Lunacy  Commissions  and  its 
Reports  in  1844.  The  influence  of  the  Washingtonian  Movement  in 
1840.  Work  of  Dr.  Turner,  beginning  in  1846.  The  first  asylum 
opened  at  Binghamton,  N.  Y.  in  1864.  The  first  medical  society  to 
take  up  this  subject  in  1870.  The  first  Journal  published  devoted 
to  this  subject  in  1876.  Other  Journals  published.  The  Interna- 
tional Congress  on  Inebriety  in  1887.  The  s'ow  recognition  of 
the  subject  and  the  laws  which  govern  its  growth.  Difficulties 
which  the  study  encountered. 

Among  the  many  references  to  inebriety  in  the  Greek 
literature  was  that  of  Herodotus,  who  wrote  in  the  fifth 
century  before  the  Christian  era.  He  asserted  that  drunk- 
enness was  a  madness  and  sickness  of  both  soul  and  body, 
which  could  be  overcome  by  proper  remedies  and  methods. 
Diodorus  and  Plutarch  also  declared  that  the  drink 
madness  was  an  affection  of  the  body,  which  had  not  only 
destroyed  kings  and  nobles,  but  had  done  infinite  damage 
to  the  world,  and  they  followed  these  statements  with  sug- 
gestions of  how  to  correct  and  remove  these  maladies. 

For  several  centuries  the  physical  causes  of  inebriety 
were  recognized  by  the  Greek  philosophers,  who  insisted 
upon  the  tendency  of  this  affliction  to  transmit  itself  to 
the  next  generation.  At  different  times  laws  recognizing 

this  evil  were  passed,  forbidding  women  and  boys  to  use 
22 


THE  RECOGNITION  OF  INEBRIETY  AS  A  DISEASE.     28 

wine.  Frequent  reference  was  made  to  the  madness  which 
sought  solace  in  wines  and  liquors,  and  in  Spartan  times 
very  severe  restrictions  were  enacted  against  the  use  of 
liquors  during  athletic  training,  and  urgent  council  given 
to  abstain  from  wine  when  any  great  work  was  to  be  done. 

In  the  first  century  of  this  Christian  era,  St.  John 
Chrysostom  urged  that  drunkenness  was  like  dyspepsia, 
and  was  a  physical  madness,  which  could  be  prevented, 
and  should  be  treated  as  any  other  ailment.  In  the  next 
century  Ulpian,  the  Roman  jurist,  referred  to  the  irre- 
sponsible character  of  inebriates,  and  the  wisdom  and 
necessity  of  treating  them  as  sick  men.  His  views  were 
embodied  in  several  laws,  which  clearly  distinguished  the 
physical  nature,  and  need  of  physical  treatment  of  such 
cases.  Ulpian's  commentaries  on  Roman  laws  contain 
many  references  to  these  enactments.  The  literature  of 
Roman  civilization  affords  abundant  evidence  that  drunk- 
enness was  recognized  as  a  bodily  disorder  often  uncon- 
trollable, and  frequently  resulting  in  veritable  madness. 

In  the  13th  century,  one  of  the  kings  of  Spain  enacted 
laws  recognizing  inebriety  as  a  disease,  lessening  the  pun- 
ishment of  the  crime  committed  while  under  the  influence 
of  spirits.  One  of  these  laws  provided  that  when  murder 
was  committed  during  intoxication,  the  death  penalty 
should  be  remitted,  and  the  prisoner  be  banished  to  some 
island  for  a  period  not  less  than  six  years.  In  the  six- 
teenth century  the  penal  codes  of  France  and  many  of  the 
German  states  contained  enactments  which  recognized  the 
disease  basis  of  inebriety.  All  punishment  for  crimes 
committed  during  these  states  varied  according  to  the  con- 
ditions of  the  prisoner  at  the  time.  Drunkenness  con- 
tinued beyond  a  certain  point,  was  regarded  as  a  condition 
of  insanity  and  irresponsibility.  In  many  of  the  medical 
writings  of  the  age,  drunkenness  and  madness  were  men- 


24  INEBRIETY. 

tioned  as  synonymous,  and  curious  ideas  concerning  the 
nature  and  treatment  of  the  evils  are  recorded. 

In  1745,  Condillac,  a  French  philosopher,  wrote,  ex- 
pressing clear  views  of  the  disease  of  inebriety,  also  that 
the  state  should  recognize  and  provide  means  for  its  treat- 
ment. He  asserted  that  the  impulse  to  drink  was  like  in- 
sanity, an  affection  of  the  brain  which  could  not  be 
reached  by  law  or  religion.  Dr.  Benjamin  Rush,  of 
Philadelphia,  in  his  lectures  given  in  1790,  set  forth  the 
same  theory,  supported  by  a  long  train  of  reasoning. 
To  him  belongs  the  honor  of  first  elaborating  and  out- 
lining ideas  which  were  accepted  half  a  century  later. 
In  two  essays  entitled  "The  Influence  of  Physical  Causes 
Upon  Moral  Faculties"  and  "An  Inquiry  into  the  Effects 
of  Ardent  Spirits  upon  the  Human  Body  and  Mind,"  he 
described  the  disease  of  inebriety,  dividing  it  into  acute 
and  chronic  forms,  giving  many  of  the  causes,  of  which 
heredity  was  a  prominent  one;  also  urging  that  special 
measures  be  taken  in  the  treatment,  which  should  be  in  a 
hospital  for  the  purpose.  At  this  time  his  views  were 
clear  and  distinctive,  although  they  were  not  published  in 
book  form  until  1809.  They  were  entirely  independent 
of  all  previous  observations.  In  1802  Dr.  Cabanis,  of 
Paris,  wrote  fully  endorsing  the  views  of  Condillac,  that 
inebriety,  like  insanity,  was  a  disease  that  should  be 
studied,  and  that  it  was  a  distinct  form  of  mental  dis- 
order, needing  medical  care  and  treatment.  Professor 
Platner,  of  Leipsic,  published  a  paper  in  1809  (the  same 
year  Rush's  writings  appeared),  affirming  that  inebriety 
was  like  an  insane  impulse  and  a  form  of  insanity  which 
should  receive  medical  care  and  be  studied  by  the  aid  of 
science.  In  1817  Salvator,  of  Moscow,  a  physician  of 
some  eminence,  published  a  pamphlet  entitled  "Ebriosity, 
its  Pathology  and  Treatment."  He  divided  drunkenness 
into  two  forms,  remittent  and  intermittent,  and  urged  that 


THE  RECOGNITION  OF  INEBRIETY  AS  A  DISEASE.     25 

they  be  treated  by  physical  means.  Esquirol,  in  1818, 
described  a  condition  of  the  nervous  system  which  caused 
inebriety.  In  1822,  Buhl  Cramner,  a  distinguished  phy- 
sician of  Berlin,  wrote  a  small  book  defining  inebriety  as  a 
state  of  irritation  of  the  brain  and  nervous  system,  to  be 
cured  by  physical  means,  because  it  was  purely  of  physical 
origin.  In  Europe  the  writing  of  these  four  men,  Platner, 
Salvator,  Esquirol  and  Cramner,  placed  the  subject  on  a 
scientific  basis,  paving  the  way  for  a  wider  and  more 
thorough  study.  Although  Dr.  Rush  had  written  on  the 
general  subject  more  definitely  than  the  others,  yet  his 
writings  were  practically  unknown. 

Dr.  Eli  Todd,  superintendent  of  the  Hartford  Retreat 
for  the  Insane,  began  to  urge  in  1828  that  the  inebriate 
be  treated  as  insane.  This  was  taken  up  by  a  committee 
of  the  Connecticut  State  Medical  Society  in  1830,  which 
reported  on  the  necessity  of  an  asylum  for  the  medical 
care  and  treatment  of  inebriates.  They  recommended  in 
an  elaborate  essay  that  it  was  expedient  to  establish  such 
an  asylum  for  the  cure  of  inebriates.  This  report  was 
written  by  Dr.  Todd,  and  was  a  strong  plea  for  the  recog- 
nition of  inebriety  as  a  disease,  and  of  its  curability  by 
physical  means.  This  report  was  published  in  the  trans- 
actions of  the  Connecticut  State  Medical  Society  and  is 
remarkable  for  its  clear  conception  of  the  subject,  so  far 
beyond  the  current  opinions  of  that  time.  In  1833  Dr. 
Woodard,  of  Worcester,  Mass.,  in  his  yearly  report, 
urged  that  inebriety  is  a  disease,  and  curable  as  other 
diseases  in  asylums  for  this  purpose.  This  called  new 
attention  to  the  subject  and  was  the  beginning  of  a  liter- 
ature which  has  attained  much  prominence,  especially  in 
this  country.  In  1839,  Dr.  Roesch,  of  Tubingen,  in  a 
volume  on  "Spirituous  Liquors,"  urged  that  inebriety  be 
considered  a  disease.  He  elaborated  the  idea  and  pointed 
out  the  errors  of  other  authors  at  some  length.  The 


26  INEBRIETY. 

English  Lunacy  Commission  in  their  report  in  1844  urged 
that  inebriates  should  be  regarded  as  insane,  sent  to  asy- 
lums for  treatment,  and  not  punished  as  before.  Dr. 
Nassc,  of  Boon,  followed,  urging  the  same  view,  in  a 
pamphlet  which  was  widely  circulated. 

Despite  the  weight  and  authority  of  these  scientific 
men,  their  views  attracted  little  or  no  attention ;  if  noticed 
it  was  with  derision  and  scorn.  Although  the  Washing- 
tonian  movement  of  1840  brought  the  matter  of  inebriety 
into  great  prominence,  the  interest  was  ephemeral,  and 
soon  forgotten.  Yet  the  records  were  important,  for  the 
men  inaugurated  a  new  movement,  and  gave  the  world  a 
clearer  conception  of  the  cause  of  alcoholism,  started  the 
modern  scientific  medical  men  in  their  search  for  the 
causes  of  the  drink  evil  in  the  weakened  or  diseased  con- 
dition of  those  who  became  its  victims. 

Therefore,  in  1846,  Dr.  J.  Edward  Turner,  of  Maine, 
began  a  most  enthusiastic  effort  to  found  an  inebriate 
asylum  for  the  physical  care  and  treatment  of  this  class. 
By  herculean  efforts  against  great  opposition,  he  suc- 
ceeded in  founding  an  asylum  at  Binghamton,  New  York. 
In  1864,  twenty  years  later,  it  was  changed  to  an  insane 
asylum.  The  history  of  this  work  will  appear  in  another 
chapter.  In  1870  a  medical  society  was  formed,  which 
still  continues  its  work  in  the  study  of  this  subject,  and 
in  1876  the  Journal  of  Inebriety  was  first  published  as  its 
organ.  In  1884  a  kindred  society  with  a  like  purpose 
was  established  in  London. 

In  1887  an  international  congress  was  held  in  London, 
in  which  leading  men  from  all  parts  of  the  world  met  and 
read  papers  demonstrating  the  progress  in  the  study  of 
the  physical  causes  of  this  subject.  The  growth  of  the 
theory  of  inebriety  being  a  disease,  and  its  practical 
recognition  in  the  last  century,  will  be  traced  in  the  next 
chapter,  but  at  this  point  it  will  be  interesting  to  notice 


THE  RECOGNITION  OF  INEBRIETY  AS  A  DISEASE.     27 

the  fact  that  this  great  subject  is  traveling  identically  the 
same  path,  with  the  same  history  that  has  marked  the 
progress  of  every  great  scientific  truth.  First  a  period 
of  denial,  indifference,  want  of  recognition  and  general 
skepticism ;  the  world  practically  deaf  to  all  statements 
made,  the  advocates  treated  with  contempt,  their  claims 
denied,  with  contemptuous  pity  for  their  ignorance. 
They  are  greeted  with  opprobrious  terms,  called  cranks, 
enthusiasts,  and  persons  pursuing  a  visionary  project 
without  merit  or  reality.  Now,  the  second  stage  is  the 
opposite  of  the  first,  that  of  credulous  acceptance,  and 
extravagant  recognition  and  endorsement  of  the  claims 
made.  This  is  the  era  of  charlatanism,  where  quacks  rush 
in  and  take  advantage  of  public  credulity  and  expecta- 
tion, exploiting  the  facts  in  the  most  extravagant  way, 
and  turning  them  to  personal  advantage,  claiming  im- 
possible results,  and  filling  the  air  with  wild  statements  of 
discoveries  and  realities  undreamed  of  before.  Then 
conies  a  reaction,  and  a  third  stage  follows ;  that  of 
critical  inquiry  into,  and  recognition  of,  the  facts  and 
their  meaning,  that  of  the  application  of  rational  means 
and  of  the  full  development  of  the  subject,  along  lines 
of  exact  science.  This  law  of  movement  is  illustrated  in 
the  discovery  of  new  countries,  where  the  first  reports  of 
its  wealth  and  fertility  are  treated  with  skeptical  indif- 
ference for  a  time.  Then  comes  the  squatter  period,  of 
persons  who  move  in,  establish  towns  and  make  the  most 
extravagant  assertions  about  its  richness  and  value.  They 
are  called  the  boomers.  After  a  few  years  they  sell  out 
and  disappear  and  the  actual  settlers  arrive. 

They  occupy  the  lands  and  develop  its  resources  along 
rational  normal  lines.  Almost  every  territory  and  new 
country  has  passed  through  these  stages,  particularly  in 
the  far  West. 


£8  INEBRIETY. 

The  claim  that  inebriety  is  a  disease  has  passed  its  first 
stage  of  indifference  and  denial.  The  second  stage  of 
credulity  has  come  and  nearly  passed  away,  and  now  the 
third  stage  of  critical  study  and  scientific  recognition  of 
the  facts  and  their  meaning  is  at  hand.  Back  of  this  uni- 
form order  of  events  so  common  in  the  evolutionary 
growth  of  truth,  is  another  factor  which  is  not  well  recog- 
nized, namely,  the  intensity  of  American  civilization,  and 
the  practical  demand  that  theories  and  practice  shall  cor- 
respond and  not  antagonize  each  other.  The  question 
now  is,  if  inebriety  is  only  a  vice  and  moral  lapse  in  the 
progress  of  man,  why  are  not  the  measures  used  to  over- 
come this  condition  successful?  Why  are  not  the  tre- 
mendous influences  at  work  in  church  and  state  more 
effectual  in  checking  its  growth?  If  it  is  a  disease  in- 
cident to,  and  a  part  of,  modern  civilization,  then  the 
question  of  its  recognition  would  seem  to  afford  the  only 
promise  of  relief.  It  is  these  facts  that  force  themselves 
before  the  public,  demanding  examination  and  scientific 
study,  that  must  be  answered  before  any  clear  conception 
can  be  had  of  the  present  conditions. 


CHAPTER   III. 

EFFORTS  TO  STUDY  INEBRIETY  FROM  A  SCIENTIFIC 
POINT  OF  VIEW. 

Synopsis. — Assertions  that  inebriety  is  a  disease  bitterly  dis- 
puted. Insanity  thought  to  be  the  possession  of  the  devil,  while 
inebriety  was  recognized  as  a  disease  at  that  time.  Washingtonian 
Movement  of  1840  destroyed  many  old  theories.  Physical  means 
for  cure  came  into  prominence  at  this  time.  Literature  on  in- 
ebriety opposed.  This  opposition  brought  it  into  prominence.  Dr. 
Turner's  efforts.  The  inebriate  asylum  at  Binghamton  attracted 
great  attention.  Resulted  in  a  new  discussion  of  the  subject. 
Other  efforts  disputed  gave  renewed  prominence.  Other  insti- 
tutions opened  and  were  the  center  of  credulity  and  opposition. 
First  medical  society  and  the  first  journal  increased  the  agita- 
tion and  discussion  of  the  subject.  The  early  books  and  their 
influence.  Early  pioneers  and  their  work.  Differences  of  opinion. 
The  first  Congress  on  the  subject.  The  combination  of  two  soci- 
eties in  this  country.  Various  controversies  and  assertions  which 
were  disputed.  Some  curious  theories.  The  last  two  congresses 
against  the  use  of  alcohol  and  their  influence. 

The  assertion  that  inebriety  is  always  a  voluntary  vice 
and  a  moral  disorder,  particularly  in  the  first  stages,  and 
that  the  disease  theory  is  untrue,  materialistic,  and  un- 
sound, is  urged  by  persons  with  little  practical  knowledge 
of  the  subject.  Much  controversy  has  arisen  and  many 
books  have  been  written  on  this  phase  of  the  subject;  but 
latterly  all  are  so  modified,  and  the  former  theories  de- 
fended so  very  feebly  that  they  appear  like  echoes  from 
the  past. 

It  is  a  curious  fact  that  the  theory  that  inebriety  is  a 
disease  was  advanced  and  defended  in  many  scientific  cir- 
cles and  by  many  eminent  men,  long  before  insanity  was 
considered  anything  more  than  spiritual  madness,  or  a 
possession  of  the  devil. 

In  the  second  century  of  the  Christian  era,  drunkenness 
was  believed  to  be  a  disease,  while  insanity  was  thought  to 
be  a  mere  possession  by  evil  spirits.  Then  these  theories 

29 


SO  INEBRIETY. 

died  away,  and  the  "vice"  explanation  of  drunkenness 
came  into  prominence.  During  the  last  half  century  the 
disease  theory  of  inebriety  has  been  urged  and  denied 
with  great  intensity;  and  in  the  sharp  reaction  of  extrav- 
agant credulity,  quack  specifics  and  gold  cures  were  ad- 
vocated; now  the  subject  is  coming  up  to  the  level  of 
exact  study  and  scientific  inquiry. 

The  Washingtonian  movement  of  1840,  in  which  more 
than  five  million  persons  were  pledged  to  a  life  of  total 
abstinence,  was  a  great  clearing  house  movement,  break- 
ing up  old  theories  and  giving  new  ideas  of  the  nature 
and  character  of  inebriety.  It  was  literally  a  sudden  and 
intense  projection  of  the  ideas  of  the  moral  side  of  inebri- 
ety, into  public  thought,  and  while  it  reacted  when  the 
reform  wave  died  out,  it  served  to  mobilize  and  concen- 
trate public  attention  upon  the  question,  of  how  far  the 
inebriate  could  control  his  malady,  and  what  efforts  were 
needed  to  enable  him  to  live  temperately.  This  first 
practical  effort  to  settle  these  questions  was  the  beginning 
of  the  organization  of  lodging  houses  for  the  members  of 
the  societies  who  had  failed  to  carry  out  the  pledges  which 
they  had  made.  This  was  really  the  beginning  of  the  hos- 
pital system  of  cure,  and  was  the  first  means  used  to  give 
practical  help  to  the  inebriate,  in  a  proper  home,  with 
protection,  until  he  was  able  to  go  out,  with  a  degree  of 
health  and  hope  of  restoration. 

One  of  these  lodging  houses,  established  in  Boston, 
Mass.,  in  1857,  has  grown  into  the  Washingtonian  Home 
of  the  present  day,  and  is  one  of  the  first  and  oldest  insti- 
tutions in  the  world  for  the  physical  care  of  inebriates. 
During  half  a  century  this  institution  has  treated 
thousands  of  patients  and  is  literally  the  pioneer  in  the 
physical  care  and  treatment  of  inebriates.  In  1846,  Dr. 
J.  Edward  Turner,  a  physician  of  Bath,  Maine,  became 
interested  in  an  effort  to  found  and  build  an  institution 


EFFORTS  TO  STUDY  INEBBTETY.  31 

for  inebriates.  His  idea  was  to  establish  an  asylum  in  the 
country,  where  they  could  be  treated  as  suffering  from 
physical  disease,  and  where  suitable  surroundings  and 
proper  remedies  could  be  applied  to  break  up  and  destroy 
the  malady.  Each  inebriate  was  to  be  recognized  as  dis- 
eased and  sick,  requiring  first,  physical  restraint  and  con- 
trol, and  then  forced  to  live  a  rational  and  normal  life 
and  be  treated  with  remedies  that  would  help  to  bring 
about  full  restoration.  All  questions  of  pledges,  will- 
power, and  moral  suasion  were  to  be  put  aside  and  the 
patient  was  treated  as  a  semi-lunatic,  or  border-land  in- 
sane man.  For  eighteen  years  he  pressed  this  idea  with  a 
reformer's  zeal  and  energy,  preaching  the  one  doctrine 
that  inebriety  was  a  disease,  and  curable  by  wise  treat- 
ment in  an  institution,  with  a  singleness  of  purpose  and 
zeal,  which  resembled  the  work  of  the  old  martyrs.  The 
opposition  which  he  met  was  very  intense,  particularly 
from  religious  and  other  societies.  It  was  urged  that  it 
was  sacrilege  to  attempt  by  physical  means  to  remedy  a 
condition  which  only  spiritual  measures  could  reach.  To 
others  it  seemed  foolishness  to  assume  that  drunkenness 
was  a  disease  and  by  this  means  excuse  vice  and  immoral- 
ity, and  lessen  the  degree  of  personal  responsibility. 

Notwithstanding  all  this  opposition  a  large  amount  of 
money  was  raised,  and  in  1864  a  magnificent  building  at 
Binghamton,  N.  Y.,  was  opened  for  the  reception  of 
patients.  It  was  managed  by  a  company  of  which  the 
famous  surgeon,  Dr.  Valentine  Mott,  of  New  York,  was 
president.  Laws  were  passed  incorporating  it  among  the 
public  institutions  of  the  state,  and  giving  it  power  to 
control  its  inmates.  An  army  of  chronic  and  degenerate 
inebriates  were  sent  to  this  institution  with  most  extrava- 
gant expectations,  and  soon  after,  they  began  to  form 
centers  of  opposition  among  themselves  and  friction  with 
the  management  arose.  They  objected  to  the  restraint 


82  INEBRIETY. 

and  to  other  measures,  insisted  on  having  full  liberty,  and 
denied  that  there  was  any  disease.  This  increased  the 
difficulties  of  successful  treatment.  The  board  of  trustees 
became  involved  and  a  most  bitter  acrimonious  controversy 
followed.  As  a  result,  Dr.  Turner,  the  founder,  was 
forced  to  leave,  and  the  institution  was  placed  in  the  care 
of  the  State  of  New  York,  and  soon  passed  into  the  hands 
of  managing  politicians. 

Its  history  from  that  time  to  1889  was  a  succession  of 
changes,  experiments  and  unscientific  efforts,  to  care  for 
and  restore  the  inebriate.  Dr.  Turner,  who  had  literally 
organized  and  built  the  institution,  giving  over  a  quarter 
of  a  century  of  his  time  and  his  own  personal  fortune, 
shared  the  fate  of  most  reformers  and  benefactors  of  the 
world  in  being  driven  out  from  the  creation  of  his  own 
genius.  A  few  years  after  he  wrote  a  book  entitled  "The 
History  of  the  First  Inebriate  Asylum  in  the  World,"  * 
in  which  the  story  of  this  controversy  and  the  injustice 
and  wrong  which  centered  about  it,  is  described.! 

After  nearly  twenty  years  of  controversy  the  state 
changed  this  institution  into  a  hospital  for  the  chronic 
insane.  During  the  time  it  was  used  for  the  care  of  in- 
ebriates, nine  different  physicians  were  superintendents, 
and  each  one  attempted  to  solve  and  treat  one  of  the  most 
difficult  and  complex  neuroses  without  previous  training  or 
experience.  Of  the  three  thousand  or  more  patients  under 
treatment  during  that  period,  the  vast  majority  repre- 
sented the  most  difficult  chronic  cases,  and  yet  the  results 
of  the  treatment  was  a  matter  of  astonishment,  details  of 


*  Copies  of  this  book  can  be  had  from  Dr.  T.  D.  Crothers,  of 
Hartford,  Conn. 

t  The  American  Medical  Society  for  the  Study  of  Alcohol  and 
other  Narcotics  erected  a  monument  over  the  grave  of  Dr.  Turner, 
at  "Wilton,  Conn.,  October  27,  1909.  Commemorative  addresses  were 
delivered  by  Doctors  L.  D.  Mason.  H.  O.  Marcy,  T.  D.  Crothers,  and 
others.  This  will  be  embodied  in  a  memorial  volume  in  the  future. 


EFFORTS  TO  STUDY  INEBRIETY.  33 

which  will  appear  in  another  chapter.  Binghamton,  as 
a  pioneer  hospital,  roused  intense  interest  by  the  oppo- 
sition, as  well  as  the  most  extravagant  endorsement  of 
its  friends.  Both  skepticism  and  credulity  rushed  to 
conclusions  in  regard  to  the  work  and  its  possibilities, 
ignoring  the  fact  of  the  magnitude  of  the  subject  and  the 
necessity  for  years  of  exact  study  and  observation,  neces- 
sary to  understand  and  treat  the  inebriate.  The  organ- 
ization of  this  hospital  was  followed  by  over  a  dozen 
different  institutions  with  a  similar  purpose.  With  the 
exception  of  one  or  two  they  have  all  disappeared. 

In  1870,  a  number  of  the  superintendents  of  these  hos- 
pitals and  physicians  interested  in  the  physical  study  of 
the  subject  organized  a  society  called  The  Association  for 
the  Study  of  Inebriety.  This  has  held  annual  and  semi- 
annual meetings  up  to  the  present  time,  at  which  the 
literature  and  the  general  study  of  the  subject  has  been 
the  special  purpose.  Its  papers  and  work  were  very 
severely  criticized  at  first,  but  the  criticism  served  only  to 
bring  the  work  into  greater  prominence.  In  1876  this 
association  established  a  journal  called  the  Quarterly 
Journal  of  Inebriety,  which  has  been  published  regularly 
from  that  time  on.  It  has  been  the  medium  through 
which  all  the  principal  studies  of  the  subject  have  been 
published.  Like  the  society  it  has  been  bitterly  con- 
demned, particularly  by  the  religious  press,  and  even  the 
medical  press  have  looked  down  upon  its  work  as  un- 
worthy of  scientific  notice.  Strangely,  from  the  first,  it 
was  more  warmly  welcomed  abroad  than  at  home.  Many 
of  its  articles  translated  into  foreign  languages  have  had 
great  influence  in  changing  public  sentiment  concerning 
the  inebriate. 

In  1884,  a  similar  society  for  the  study  of  inebriety 
was  formed  in  England,  with  the  late  Dr.  Kerr  as  presi- 
dent. This  society  has  been  very  influential  and  its  regular 


34  INEBRIETY. 

meetings  in  London  attract  much  attention  by  the  reading 
and  discussion  of  most  excellent  papers.  Societies  of 
similar  character,  giving  greater  prominence  to  the  action 
of  alcohol,  have  been  formed  in  France,  Germany,  Switz- 
erland, Sweden,  and  Spain. 

In  1887,  an  international  congress  was  held  in  London 
for  the  discussion  of  the  disease  of  inebriety,  and  the 
means  of  its  prevention  and  cure.  Delegates  from  Amer- 
ica and  most  of  the  countries  of  Europe  were  present. 
The  papers  and  discussions  were  published  and  created  a 
widespread  interest. 

In  1902,  the  English  society  established  The  British 
Journal  of  Inebriety  as  its  organ,  and  for  the  publication 
of  its  transactions.  It  will  thus  be  seen  that  the  public 
efforts  to  study  this  subject  from  a  scientific  point  of 
view,  particularly  through  societies  and  journals,  have 
been  constantly  growing. 

The  change  of  the  Binghamton  hospital  to  one  for  the 
care  of  the  insane,  was  regarded  at  the  time  as  a  serious 
misfortune,  but  recent  events  have  shown  that  public 
sentiment  was  not  far  enough  advanced  to  recognize  its 
real  work,  or  to  support  it,  and  that  its  management  by 
politicians  and  non-experts  would  only  increase  the  diffi- 
culties. Other  institutions,  based  on  special  theories  of 
what  inebriety  is  or  is  not,  have  failed  to  stand  the  test  of 
experiment  and  so,  after  a  time,  were  abandoned.  Had 
these  early  institutions  been  managed  by  scientific  men 
and  students,  and  the  chronic  condition  of  the  inmates 
been  recognized  and  had  they  received  the  support  of 
the  public,  and  full  legal  power  of  control,  very  dif- 
ferent results  would  have  followed. 

Notwithstanding  all  these  difficulties,  the  number  of 
persons  restored  and  the  bitter  experience  gained,  in- 
dicated great  possibilities  from  a  clearer  knowledge  and  a 
more  perfect  organization. 


EFFORTS  TO  STUDY  INEBRIETY.  35 

Many  of  the  early  members  of  the  Association  for  the 
Study  of  Inebriety,  published  books  in  addition  to  their 
contributions  to  the  Journal.  Dr.  Albert  Day,  superin- 
tendent of  the  Washingtonian  home  at  Boston  for  thirty 
years,  issued  one  of  the  earliest  books,  called  "Metho- 
mania" ;  describing  clearly  the  disease  of  drinking  and 
pointing  out  the  possibilities  of  cure.  Later  Dr.  Joseph 
Parish,  who  was  for  a  long  time  superintendent  of.  in- 
ebriate homes  near  Baltimore  and  Philadelphia,  issued  a 
book  called  "Alcoholic  Inebriety,"  which  gave  a  very 
suggestive  idea  of  the  disease  and  its  treatment.  Later 
Dr.  T.  L.  Wright,  of  Belief ontaine,  Ohio,  published  a 
very  philosophic  book  called  "Inebriasm,"  which  was 
widely  read  and  added  much  to  the  subject.  Dr.  Willard 
Parker,  of  New  York,  and  Dr.  T.  L.  Mason,  of  Brook- 
lyn, both  wrote  excellent  monographs  on  inebriety,  which 
were  widely  read  at  the  time.  In  1893,  Dr.  Norman 
Kerr,  an  honorary  member  of  the  Association  wrote  a 
text-book,  called  "Inebriety  and  Narcomania."  This  has 
been  the  leading  text-book  and  is  the  most  widely  circu- 
lated and  influential  volume  on  the  subject.  In  1893  the 
secretary  of  the  Association  for  the  Study  of  Inebriety 
compiled  papers,  which  had  appeared  in  the  Journal,  and 
published  them  in  a  volume  entitled  "The  Disease  of  In- 
ebriety." This  work  has  been  largely  circulated.  In 
1901  the  writer  issued  a  small  volume  on  "Drink  Habits" 
and  the  same  year  a  larger  volume  on  "Morphinism," 
both  of  which  have  been  widely  read. 

Abroad,  among  the  honorary  members  of  this  Associa- 
tion, M.  Magnan,  of  Paris,  France,  issued  a  large  volume 
on  "Alcoholism."  Dr.  Lentz,  of  Brussels,  published  a 
volume  on  "The  Manifestations  of  Alcohol."  Dr.  Baer, 
of  Berlin,  issued  a  volume  called  "Alcohol  as  a  Malady." 
These  were  large  voluminous  works  and  were  followed  by 


36  INEBRIETY. 

a  number  of  smaller  works,  giving  great  prominence  to 
different  phases  of  the  subject. 

All  the  foreign  books  made  alcohol  and  its  effects  on 
the  body  the  most  prominent  topics.  The  American  works 
consider  the  disease  and  the  etiological  conditions  of  most 
interest.  The  claims  of  the  Society  for  the  Study  of  In- 
ebriety, that  the  desire  for  alcohol  is  a  symptom  of  con- 
ditions springing  from  many  causes,  has  been  practically 
ignored  in  most  of  the  discussions  on  the  general  subject. 

Both  in  England  and  this  country,  the  two  societies  for 
the  study  of  the  effects  of  alcohol  have  roused  very  intense 
controversies,  into  which  laymen  and  reformers  have 
joined  with  great  eagerness.  As  a  result,  a  large  litera- 
ture has  been  accumulated,  out  of  which  many  new  facts 
have  been  evolved,  and  old  theories  have  been  put  aside. 
In  another  chapter  some  of  the  conclusions  will  be  given, 
which  the  new  studies  of  alcohol  from  a  scientific  point  of 
view  have  made  clear. 

The  theory  that  alcohol  is  a  stimulant  and  tonic,  and 
has  some  food  value,  is  replaced  by  evidence  of  its  par- 
alyzing narcotic  action  on  both  cells  and  nerves.  The 
peculiar  palsy  resulting,  is  found  to  be  very  general,  and 
to  extend  to  the  next  generation,  appearing  in  various 
defects  and  complex  degenerations ;  and  this  is  striking 
confirmation  of  the  disease  theory. 

The  Society  for  the  Study  of  Inebriety  has  warmly 
welcomed  these  special  alcoholic  studies,  and  most  of  its 
members  took  an  active  part  in  the  work  of  the  Medical 
Temperance  Association.  This  was  formed  in  1891  un- 
der the  presidency  of  the  late  Dr.  N.  S.  Davis  of  Chi- 
cago. This  new  association  held  its  meetings  at  the  same 
time  and  place  as  the  American  Medical  Association.  Its 
papers  were  largely  confined  to  the  effects  of  alcohol  in 
health  and  disease,  and  were  published  in  a  journal  of  its 


EFFORTS  TO  STUDY  INEBRIETY.  37 

The  work  of  this  new  association  attracted  a  great  deal 
of  attention,  stimulating  new  researches  and  assisting  in 
breaking  up  the  old  theories  and  notions  of  the  physio- 
logical action  of  alcohol. 

Within  the  last  few  years,  many  of  the  medical  jour- 
nals have  taken  up  the  alcoholic  problem  in  a  controversial 
spirit;  generally  to  condemn  the  advocates  of  its  narcotic 
action,  and  support  some  of  the  theories  of  the  past;  or 
to  explain  what  seems  to  them  the  scientific  side  of  the 
subject.  Thus  in  the  year  1907  nearly  one  hundred  edi- 
torials, papers  and  addresses,  on  the  various  phases  of 
the  alcoholic  subject,  appeared  in  the  medical  press  of  this 
country  and  Canada.* 

The  two  societies,  The  Association  for  the  Study  of 
Inebriety  and  The  Medical  Temperance  Association  were 
clearly  occupying  the  same  ground,  the  one  given  prom- 
inence to  the  disease  of  inebriety  and  the  other  the  physi- 
ological and  pathological  effects  of  alcohol.  It  was 
thought  wise  that  the  societies  should  unite,  and  this  was 
accomplished  in  1904  and  the  name  of  the  combined  soci- 
eties is  The  American  Association  for  the  Study  of  Al- 
cohol and  Other  Narcotics. 

The  old  society  for  the  study  of  inebriety  started  from 
the  inebriate  and  went  back  to  the  causes  of  his  malady 
and  the  best  means  of  controlling  it.  The  new  combined 
society  adds  to  this  the  study  of  alcohol  and  other  nar- 
cotics, and  traces  their  effects  on  individuals  and  society, 
pointing  out  the  influences  that  are  inherited  and  their 
relation  to  the  psychosis  and  neurosis  of  inebriety.  This, 
while  not  a  new  point  of  view,  is  a  broader  one,  and  seeks 
an  explanation  of  why,  in  inebriety,  the  desire  for  spirits 
both  precedes  and  follows  its  use. 

The  controversy  over  the  physiological  action  of  al- 
cohol becomes  a  general  question,  not  only  to  be  settled 
in  the  laboratory,  but  from  clinical  study  at  the  bedside 

*  See  note  on  p.  38. 


38  INEBRIETY. 

and  in  institutional  care.  What  the  particular  effects  are 
on  the  organism,  and  what  contributing  causes  provoke 
its  use  and  lead  up  to  the  profound  degenerations,  are  the 
fields  to  be  explored  and  traced.  The  International  Anti- 
Alcoholic  Congress  held  at  Stockholm  in  July,  1907,  gave 
unmistakable  evidence  of  the  recognition  of  a  new  era  of 
the  scientific  study  of  the  problem. 

The  various  meetings  of  the  friends  of  temperance, 
called  congresses,  held  in  different  parts  of  Europe  for 
over  a  quarter  of  a  century,  have  been  devoted  to  the 
moral  and  hygienic  side  of  the  subject.  Few  scientific 
papers  were  presented,  and  the  whole  subject  was  consid- 
ered a  great  educational,  moral  problem.  The  Swedish 
government,  by  inviting  all  the  countries  of  the  civilized 
world  to  participate  in  this  congress,  gave  expression  to 
the  sentiment,  which  has  been  growing  for  years,  that  in- 
ebriety and  the  alcoholic  problem  must  be  studied  from 
the  scientific  side,  and  that  it  was  a  question  of  facts  and 
their  meaning,  not  of  old  theories  and  prejudices,  which 
have  prevailed  too  long. 

The  congress  held  in  1909,  in  London,  brought  out 
this  fact  more  prominently  than  ever,  and  indicated  that 
the  scientific  study  of  the  subject  precedes  every  other 
consideration.  There  can  be  no  question  that  work  in  this 
direction  will  indicate  means  and  measures  for  effectually 
stamping  out  inebriety,  and  preventing  the  evils  which 
follow  from  it,  as  is  done  in  other  diseases. 


Note. — Two  works  which  have  a  very  marked  Influence  in 
popular  scientific  literature  should  be  mentioned  as  most  sug- 
gestive studies  along  allied  lines,  viz.:  Alcohol  and  the  Human 
Body  by  Sir  Victor  Horsley  and  Dr.  Sturgis  and  the  Psychology 
of  Inebriety  by  Rev.  Dr.  Geo.  B.  Cutten.  These  are  most  com- 
mendable scientific  works. 


CHAPTER   IV. 
FORMS  AND  CLASSIFICATIONS  OF  INEBRIETY. 

Synopsis. —  The  term  inebriety  and  alcoholism.  What  they 
mean.  Illustrations  of  their  meaning.  The  conditions  present. 
Effects  of  spirits  on  healthy  persons.  The  neurosis  and  psychosis. 
Three  general  classes  of  inebriates.  First,  with  a  long  preliminary 
period  of  drinking.  Second,  persons  who  use  spirits  irregularly. 
Illustrations.  Third,  periodic  drinker.  The  impulsiveness  of  their 
use  of  spirits,  resembling  insanity.  Illustrations.  The  influence 
of  saloons  developing  this  class.  States  of  degeneracy  from 
heredity.  The  psychopathic  inebriate.  Influence  of  tuberculosis. 
General  paralysis.  Class  of  inebriates  following  injuries.  Per- 
sons who  take  spirits  for  intoxication.  Inebriates  with  obsessions 
and  insane  impulses.  Inebriates  with  criminal  impulses.  Their 
treatment  in  the  police  court.  Delusional  drinkers.  Magnan's 
classification.  Other  efforts  to  arrange  them  in  classes.  Associa- 
tions with  dyspepsia.  Illustrations.  General  considerations. 

The  term  inebriety  appears  to  be  the  most  accurate  in 
describing  the  continuous  or  occasional  impulse  or  crav- 
ing for  spirits  or  drugs.  The  late  Dr.  Norman  Kerr 
called  it  narcomania,  a  desire  or  impulse  for  relief  from 
discomfort,  unrest  and  pain. 

Alcoholism  means  accurately,  a  state  of  poisoning  by 
alcohol  and  some  special  conditions  due  to  this  toxic  state. 
Inebriety  includes  this  and  indicates  earlier  and  more 
pronounced  active  causes.  Thus,  a  man  previously  temper- 
ate is  injured,  and  suffers  from  shock  or  some  obscure 
injury,  and  without  any  preliminary  use  of  spirits,  be- 
comes an  inebriate  at  once.  Such  a  person  could  not  be 
strictly  called  an  alcoholic.  If  he  began  the  use  of  spirits 
in  great  moderation  at  first,  and  then  gradually  increased 
up  to  a  time  when  he  became  evidently  poisoned  from  its 
effects,  the  term  "alcoholism"  would  properly  describe  his 
condition.  Both  of  these  terms  "inebriety"  and  "alcohol- 
ism" represent  degrees  of  neurosis  and  psychosis  at  the 
beginning. 

39 


40  INEBRIETY. 

Probably  two  conditions,  namely,  brain  instability  and 
hypersensitivcness  to  pain  are  more  commonly  present 
than  any  other.  Where  spirits  are  used  in  small  quan- 
tities, by  persons  previously  healthy,  a  demand  will  be 
created  for  their  increased  and  continued  use.  This  is  a 
pathological  hint  of  states  of  depression  and  deranged 
functions  which  call  for  relief,  found  most  readily  in  the 
narcotism  of  alcohol. 

There  are  innumerable  classes  of  drinkers,  and  the 
effort  to  divide  them  is  beset  with  difficulties,  for  the 
reason  that  the  causes  of  the  desire  for  spirits  and  the 
resistance  of  the  body  to  spirits  are  at  present  largely 
unknown.  Practically  three  general  classes  are  apparent 
in  a  general  study.  First,  those  who  have  a  long  prelim- 
inary period  of  moderate  drinking;  beginning  with  cider, 
beer,  wine  and  then  later  taking  stronger  spirits  and  using 
the  latter  to  great  excess  at  times ;  there  appears  in  this  a 
gradual  growth  and  cultivation  of  the  drink  impulse. 
Second,  persons  who  use  spirits  infrequently  and  become 
intoxicated ;  the  causes  are  usually  accidental,  and  the 
effects  may  be  usually  pleasant  or  the  opposite.  If  the 
intoxication  is  the  culmination  of  some  physical  or  mental 
condition  of  excitement  or  depression,  the  recurrence  of 
these  conditions  will  suggest  and  stimulate  the  use  of 
spirits  up  to  the  point  of  stupor,  as  upon  former  occa- 
sions. Thus  a  number  of  persons,  who  are  total  abstain- 
ers in  all  other  conditions  of  life,  drink  to  excess  at  some 
special  times  or  upon  certain  occasions.  One  man  never 
drinks,  except  at  the  seashore ;  another  only  drinks  on  the 
occasion  of  some  great  sorrow  or  death  in  his  family,  and 
then  abstains,  until  another  similar  event  occurs.  A  num- 
ber of  old  soldiers  are  perfectly  temperate  at  all  other 
times,  but  on  occasions  of  army  reunions,  when  they  are 
frequently  intoxicated.  The  drink  craze  is  uncertain, 
and  due  to  special  exciting  causes,  which  are  largely  un- 


FORMS  AND  CLASSIFICATIONS  OF  INEBRIETY.          41 

known.  A  third  class  may  be  called  "periodic  drinkers," 
who,  at  times,  drink  to  great  excess,  with  or  without 
any  apparent  cause,  irrespective  of  conditions  or  circum- 
stances ;  their  distinct  drink  storms  resemble  epilepsy ; 
after  the  narcotism  of  the  drink  has  died  out,  they  be- 
come total  abstainers  and  have  free  intervals  of  indefinite 
length.  The  first  class  are  the  trained  and  cultivated  in- 
ebriates. The  second  are  the  unknown,  erratic,  explosive 
inebriates,  and  are  the  most  mysterious  and  unexplain- 
able. 

Often  the  person  will  give  elaborate  explanations  of  his 
condition,  describing  it  as  the  result  of  certain  special 
causes,  but  like  the  third  class,  it  may  terminate  abruptly 
when  the  system  becomes  saturated  and  profoundly  nar- 
cotized. The  third  class  of  periodic  drinkers  may  be  di- 
vided into  numerous  sub-classes,  one  of  which  includes  the 
dipsomaniacs.  This,  fortunately,  is  not  a  very  common 
condition.  It  is  marked  by  an  insane  overpowering  im- 
pulse which  is  a  veritable  mania  for  the  time  being,  and 
when  the  full  narcotism  of  spirits  comes  on,  the  impulse 
subsides. 

In  another  chapter,  varieties  of  this  form  will  be  de- 
scribed. The  periodic  drinker  appears  to  be  very  largely 
dependent  on  his  surroundings,  mental  condition,  and  de- 
gree of  health,  for  the  time  of  the  return  of  the  drink 
impulse ;  hence  all  conditions  of  exhaustion,  starvation, 
severe  strain  with  brain  and  body  fatigue,  furnish  fertile 
soil  for  the  development  and  growth  of  periodic  inebriety. 
In  this  class  are  also  included  the  inebriate  who  drinks 
from  contagion  and  emotional  causes. 

There  can  be  no  doubt  that  the  presence  of  saloons 
and  club-houses  give  increased  activity  to  states  of  in- 
herited degeneration,  and  furnish  sources  of  temporary 
relief  to  hyperasthetic  conditions,  that  could  be  diverted 
into  normal  channels  by  proper  hygienic  means. 


42  INEBRIETY. 

Many  persons  have  been  greatly  puzzled  to  explain  the 
presence  of  inebriety  in  persons  living  in  surroundings 
that  were  antagonistic  to  the  use  of  spirits,  but  reference 
to  carefully  recorded  and  studied  histories  of  other  cases 
indicate  a  range  of  natural  causes  which  have  escaped 
attention  before. 

It  will  be  shown  later  that  inebriety  and  conditions  of 
degeneracy  transmitted  from  the  parents  will  explain 
many  of  these  mysterious  outbursts  of  inebriety.  There 
is  another  class  of  inebriates  that  are  undoubtedly  becom- 
ing more  numerous.  They  may  be  termed  the  "psycho- 
pathic class."  In  them  inebriety  is  simply  another  phase 
of  existing  disease,  thus  in  tuberculosis  the  acute  symp- 
toms often  subside  when  the  patient  uses  alcohol  to  excess ; 
when  the  alcohol  is  withdrawn,  the  inflammatory  condi- 
tions of  the  lungs  start  up  again. 

The  general  paretic  always  passes  through  a  stage  of 
excessive  use  of  spirits.  The  epileptic  may  have  a  drink- 
ing spell  in  the  place  of  the  paroxysm.  Quite  a  large 
class  of  inebriates  have  a  history  of  injury  in  early  life, 
such  as  contusion,  broken  bones,  or  severe  inflammatory 
fevers  with  a  long  protracted  stage  of  invalidism  and  an 
apparent  recovery.  Another  class  give  a  history  of  nu- 
trient disturbances,  either  overfed  or  underfed.  One  au- 
thor has  made  a  division  of  the  latter  class,  calling  them 
dyspeptic  inebriates  in  which  the  digestive  disorders  are 
the  most  prominent  symptoms. 

The  late  Dr.  Parish  described  a  class  of  psychical  in- 
ebriates in  which  the  causes  are  unknown  and  confined  to 
the  realm  of  the  psychic.  The  patients  never  use  spirits 
except  at  midnight  and  then  only  for  a  brief  time.  This 
class,  termed  the  "solitary  midnight  drinkers,"  are  total 
abstainers  at  all  other  times.  Dr.  L.  D.  Mason  noted  a 
class  of  persons  who  drank  a  few  months  before  death 
and  who  were  total  abstainers  xip  to  this  period.  For 


FORMS  AND  CLASSIFICATIONS  OF  INEBRIETY.          43 

some  unknown  reasons  they  would  begin  to  use  spirits  to 
produce  continuous  intoxication  and  in  a  short  time 
Bright's  disease  or  acute  pneumonia  would  cause  death. 
Other  observers  have  noted  similar  facts  and  traced  them 
to  an  overwhelming  loss  of  vitality  and  premonition  of 
death  showing  itself  in  the  drink  impulse. 

The  late  Dr.  Wright  called  this  "senile  inebriety"  and 
described  cases  of  persons,  whose  previous  life  had  been 
temperate,  who  suddenly  began  to  use  spirits,  giving  no 
reason,  except  that  of  exhaustion,  and  dying  in  a  very 
short  time.  Another  class,  which  appears  to  be  growing 
more  prominent  every  year,  includes  persons  generally 
actively  engaged  in  business  and  professional  work,  who 
suddenly  disappear,  go  into  seclusion  and  drink  several 
days  to  great  excess ;  then  return  and  resume  their  work 
as  usual.  Such  patients  never  explain  these  attacks  and 
regard  them  as  spells.  In  reality  they  are  obsessions  and 
insane  impulses,  which  are  only  satisfied  by  profound 
narcotism  from  spirits. 

There  are  many  remarkable  divisions  of  these  insane 
inebriates  whose  drinking  resembles  nerve  explosions,  and 
often  becomes  epileptic  in  form.  One  of  these  classes  is 
that  of  the  secret  drinker,  who  never  appears  to  be  under 
the  influence  of  spirits,  and  whose  drinking  is  only  recog- 
nized in  the  sudden  changes  of  character  and  conduct. 
The  use  of  spirits  is  always  denied  and  his  conduct  be- 
comes more  secretive,  and  attempts  to  find  out  what  he  is 
doing,  are  repelled  with  great  indignation.  Many  such 
persons  die  suddenly  and  then  the  secret  drinking  becomes 
known.  The  effects  of  alcohol  vary  in  different  persons, 
but  there  are  certain  mental  changes  and  degenerations, 
whose  uniformity  cannot  be  mistaken. 

Another  very  prominent  class  of  inebriates  is  noted  by 
criminal  conduct  when  under  the  influence  of  spirits.  Al- 
cohol seems  to  provoke  intense  selfishness  and  irritability, 


44  INEBRIETY. 

with  delusions  of  persecution,  and  lack  of  respect  for  law 
or  order.  In  the  police  courts  they  are  termed  vicious 
and  treated  with  severity.  Morell,  the  French  specialist, 
described  them  as  moral  paralytics,  without  any  ethical 
notions  of  responsibility  or  duty.  They  are  often  seen 
in  the  wealthier  classes,  and  are  called  dishonest,  tricky 
and  unreliable.  There  can  be  no  question  as  to  their 
physical  defects,  whether  this  is  due  to  alcohol  or  to  some 
inherited  weakness  is  not  clear.  Probably  both  conditions 
are  active  as  causes. 

There  is  a  class  called  delusional  drinkers,  which  are 
very  large,  and  in  some  respects  prominent  among  all  in- 
ebriates. They  are  noted  for  extreme  optimism,  never 
recognizing  any  possible  danger  from  the  use  of  spirits  in 
any  form,  and  show  much  ingenuity  in  explaining  erratic 
conduct  as  due  to  other  causes.  Such  persons  pose  in  the 
papers  and  among  their  friends  as  examples  of  the  good 
effects  of  spirits  when  taken  for  years,  and  are  always 
boastful  of  what  they  can  do,  and  how  unlike  others  they 
are.  In  reality,  they  are  often  most  diseased  and  irre- 
sponsible and  the  appearance  of  sanity  is  a  very  thin  var- 
nish. Attempts  to  classify  these  cases  are  hardly  possible, 
except  in  a  general  way. 

While  the  general  symptomology  is  more  or  less  uni- 
form, there  are  so  many  variations  and  diversities  of 
defects,  and  peculiar  manifestations  of  thought  and  con- 
duct, that  it  is  difficult  to  group  them  in  any  particular 
classes.  Magnan,  of  Paris,  divides  all  alcoholics  into  two 
classes,  namely,  the  constant  and  periodic  drinkers.  The 
first  he  describes  as  senile  and  demented.  The  second  as 
maniacal  and  explosive.  Dubois  calls  all  inebriates  de- 
ments and  maniacs  from  toxic  causes.  Other  authors 
make  a  distinction  of  moral  and  functional  cases  at  the 
beginning,  and  then  organic  and  insane  farther  on. 


FOEMS  AND  CLASSIFICATIONS  OF  INEBRIETY.          45 

Delirium  tremens  is  a  special  toxic  stage  in  the  terminal 
period  of  drinking.  Many  divisions  have  been  made  and 
described  with  great  minuteness,  but  it  is  doubtful  if  these 
distinctions  are  anything  more  than  mere  external  symp- 
toms from  local  causes.  This  will  be  discussed  in  another 
chapter. 

There  is  a  sub-class  in  which  delusional  egotism  is  a 
very  prominent  symptom;  the  patient  never  acknowledges 
his  condition,  but  always  asserts  that  other  causes  than 
alcohol  are  responsible.  The  disordered  egotism  is  a  com- 
mon symptom  in  nearly  all  the  classes,  and  where  it  as- 
sumes great  prominence,  it  is  associated  with  other  pro- 
nounced degenerations,  which  are  so  apparent,  that  this 
particular  symptom  cannot  be  designated  as  special.  It 
is  a  common  observation  that  many  of  the  symptoms  are 
due  specifically  to  alcohol.  This  is  only  partially  true. 
The  patient,  who,  after  drinking,  becomes  hilarious,  and 
has  delirium  of  exhaltations  has  a  peculiar  nervous  organ- 
ization, particularly  sensitive  to  the  rapid  circulation  of 
the  blood  through  the  brain.  Often  these  symptoms  re- 
semble nerve  spasms  and  are  marked  by  great  depression. 
The  opposite  class,  who  are  suddenly  depressed  and  mel- 
ancholic from  the  action  from  alcohol,  possess  a  different 
degree  of  sensitiveness,  and  a  brain  resistance  to  the  tox- 
ins. In  one  there  is  extreme  activity.  In  the  other 
marked  depression. 


CHAPTER   V. 

INEBRIETY  IN  AMERICA  AND  ITS  PECULIARITIES. 

Synopsis. —  The  general  effects  of  alcohol  the  same  all  over 
the  world.  More  distinct  in  America.  The  moderate  drinking  per- 
iod short.  Men  seldom  use  spirits  regularly  beyond  a  limited 
time.  Spirits  are  used  impulsively.  More  periodic  drinking  than 
in  other  countries.  Due  to  the  brain  strain  and  intensity  of  liv- 
ing. General  neglect  of  rest  and  quietness.  Inebriety  in  America 
associated  with  delusions  of  wealth  and  power.  The  American  In- 
ebriate is  not  a  wife  beater,  but  a  delirious  reformer.  He  sel- 
dom commits  brutal  crimes,  but  is  a  swindler  and  promoter  of 
great  schemes.  He  dies  of  heart,  kidney  and  lung  diseases.  In- 
ebriety moves  in  waves  and  currents.  Women  drink  less  than  in 
other  countries.  Spirit  drinking  more  concealed.  A  distinct  form 
of  brain  and  nerve  psychosis.  A  form  of  insanity  due  to  the  in- 
tensity of  living.  The  atmosphere  is  psychic  and  distinct  factors 
seem  to  provoke  its  growth.  More  distinctly  inherited.  Depend- 
ent on  extremes  of  temperature,  also  on  foods.  Tobacco  a  grateful 
narcotic  and  promoter  of  inebriety.  The  American  inebriate  is 
a  bar  drinker  and  not  a  club  drinker.  He  drinks  at  night  to 
promote  sleep.  He  drinks  in  the  day  time  for  new  vigor  and 
strength.  He  has  less  descendants  because  of  the  profound  de- 
generation and  nerve  injury.  He  is  curable  under  certain  con- 
ditions. He  is  susceptible  and  wants  relief  more  quickly.  Has 
less  power  to  resist  pain.  More  pronouncedly  diseases. 

While  the  effects  of  alcohol  and  the  conditions  which 
demand  spirits  for  relief  are  practically  the  same  in  all 
climates  and  conditions,  there  are  many  well  marked  pe- 
culiarities which  distinguish  inebriety  in  America  from  that 
of  other  countries.  Thus  the  period  of  moderate  drink- 
ing is  shorter,  and  spirits  are  rarely  taken  regularly  with 
meals  more  than  a  few  months  or  one  or  two  years. 
Spirits  are  used  in  great  quantities  and  impulsively,  and 
the  effects  are  sought  for  with  precipitate  haste,  and  the 
diseases  and  mortality  which  follow  are  more  pronounced 
and  marked. 

Many  authors  have  recognized  the  fact  that  few  persons 
in  active  life  drink  spirits  in  so-called  moderation  in  this 
country.  The  attempts  to  pattern  after  the  customs  of 

Europe,  in  having  wine  at  the  table  and  spirits  at  regular 
46 


INEBRIETY  IN  AMERICA  AND  ITS  PECULIARITIES.      47 

intervals,  ends  disastrously,  either  in  excessive  use,  or  some 
form  of  disease  and  invalidism.  In  active  business  circles 
the  excessive  drinking  and  sudden  collapse  of  men  previ- 
ously supposed  to  be  temperate,  are  examples  of  the  fail- 
ure to  drink  moderately. 

It  is  noted  that  business  men  with  a  reputation  for  con- 
servatism and  reliable  conduct,  who  suddenly  become 
speculators  and  erratic  in  their  judgment,  are  often  found 
to  be  moderate  drinkers.  Such  persons  have  delusions  of 
immediate  wealth,  power,  and  political  achievement,  and 
very  soon  break  down  from  the  excessive  use  of  spirits. 
Evidently,  drinking  has  destroyed  their  good  sense  and 
judgment.  Among  the  reasons  explaining  this  inability 
to  use  spirits  in  small  quantities  for  any  length  of  time, 
are  the  intensity  of  living,  the  constant  excitement,  and 
the  rapid  changes  in  both  business  and  social  circles,  and 
the  constant  strain  of  every  energy  of  the  body  to  adapt 
itself  to  the  varying  conditions.  Associated  with  this  is 
the  neglect  of  the  ordinary  functions  of  the  body,  par- 
ticularly those  of  rest,  sleep  and  nutrition,  states  of  ex- 
haustion follow  for  which  alcohol  is  taken  to  give  relief 
and  rest.  The  average  drinker,  in  the  psychical  atmos- 
phere of  America,  finds  the  necessity  and  occasion  for 
using  spirits  at  any  time,  for  their  effects;  and  if  they 
are  not  sufficiently  potent  more  is  taken  until  the  system 
becomes  saturated. 

If  this  saturation  becomes  a  marked  intoxication,  he  is 
likely  to  be  disgusted  and  abstain  for  a  short  time;  and 
then  start  again,  with  a  determination  not  to  exceed  a 
small  quantity  at  regular  intervals.  Sooner  or  later 
this  amount  is  exceeded  and  another  intoxication  follows. 
Thus  the  average  business  man,  who  tries  to  imitate  the 
European  in  taking  wine  at  meals,  or  small  quantities  of 
spirits  at  fixed  intervals,  finds  it  impossible  and  becomes 
an  irregular  and  spasmodic  drinker. 


48  INEBRIETY. 

The  foreign  born  resident  who  continues  his  former 
customs  of  taking  wine  and  beer,  after  a  few  years  be- 
comes nervous  and  suffers  from  some  form  of  neurosis  and 
dies  suddenly ;  while  his  brother  abroad,  using  spirits  in 
substantially  the  same  way,  seems  to  suffer  less.  The 
effects  of  American  life  is  thus  marked  in  the  character 
of  the  derangement  which  follows  from  the  use  of  spirits ; 
the  vast  majority  of  persons  are  unable  to  drink  small 
quantities  for  any  length  of  time  and  soon  become  im- 
pulsive and  excessive  drinkers  at  intervals. 

The  average  American  inebriate  is  peculiar  for  the  de- 
lusions of  egoism  and  ambition  to  acquire  wealth  and 
power.  He  seems  to  be  alert  to  seize  opportunities  to 
lead  in  great  schemes  for  his  own  welfare  and  that  of 
others.  He  is  rarely  a  wife-beater  or  an  avenger  of  per- 
sonal wrongs,  but  joins  mobs  and  all  new  efforts  to  break 
up  some  supposed  wrongs  that  are  blocking  the  wheels  of 
progress.  The  records  of  courts  contain  few  examples  of 
brutal  crimes  committed  by  native  born  inebriates.  Their 
offenses  are  frauds,  swindles,  schemes  of  deception,  or 
revolutions  for  profit  and  social  reform ;  often  they  be- 
come strikers  and  redressers  of  wrongs,  or  promoters  of 
some  new  projects  in  politics,  religion  or  business,  and 
like  Colonel  Sellers,  "buoyed  up  with  the  hope  that  there 
are  millions  in  it." 

The  American  inebriate,  even  in  the  submerged  class, 
seldom  commits  suicide,  but  dies  from  hemorrhage  or  acute 
inflammation,  and  in  the  hospital  or  workhouse  they  have 
little  or  no  resisting  power  and  succumb  to  any  adverse 
causes  or  conditions.  Dr.  C.  H.  Hughes  has  declared  that 
the  use  of  alcohol  in  America  is  a  distinct  form  of  brain 
and  nerve  psychosis,  which  in  many  ways  resembles  gen- 
eral paresis,  also  that  the  use  of  alcohol  in  America  is  far 
more  dangerous  and  fatal  than  in  any  other  country. 
The  excessive  mortality  from  diseases  of  the  lungs,  heart 


INEBRIETY  IN  AMERICA  AND  ITS  PECULIARITIES.      49 

and  kidneys  noted  among  inebriates  in  this  country  is  a 
very  strong  confirmation  of  the  above  statement. 

From  a  great  variety  of  evidence  there  are  many  rea- 
sons for  believing  that  inebriety  in  America  is  controlled 
by  some  unknown  psychological  wave  movement.  Some 
of  the  facts  gathered  from  different  studies  indicate  such 
a  movement  with  a  duration  of  from  twelve  to  sixteen 
years.  This  is  based  on  the  records  of  towns  and  cities 
where  it  would  seem  that  the  arrests  for  drunkenness  slow- 
ly increase  up  to  a  certain  point,  and  then  decrease  in  a 
sort  of  an  ebb  and  flow  current.  These  waves  are  noted 
by  an  unusual  interest  in  temperance  work,  and  great 
efforts  to  control  and  diminish  the  sale  of  spirits.  After 
a  while  they  culminate  in  some  high  point  of  intense  ac- 
tivity, in  society,  churches  and  organizations,  then  they 
subside  for  a  while,  and  in  a  few  years  start  up  again, 
reaching  a  certain  high  point  and  then  declining.  Several 
very  marked  examples  have  been  traced  in  the  various 
crusades  to  diminish  inebriety.  Thus  a  high  tide  of  in- 
creased alcoholic  drinking  is  followed  by  intense  opposi- 
tion and  wide  efforts  to  check  it,  public  sentiment  is 
alarmed,  and  moral  suasion  and  other  efforts  are  intense- 
ly active  to  check  its  growth.  Apparently  they  succeed, 
and  the  use  of  spirits  diminishes.  Then  in  a  few  years  it 
reappears  again.  The  late  Dr.  Beard  wrote  that  wide- 
spread financial  disasters  and  depressions  in  business  al- 
ways bring  to  the  surface  a  new  crowd  of  inebriates,  who, 
after  a  more  or  less  ineffectual  struggle  to  recover,  die. 

It  has  been  noted  that  political  revolutions,  such  as  pro- 
nounced changes  of  parties  and  public  policies  are  followed 
by  an  increased  number  of  inebriates  in  the  higher  walks 
of  life.  This  is  readily  explained  by  the  failure  of  a 
large  number  of  neurotics  and  moderate  drinkers  to  adapt 
themselves  to  the  new  conditions  of  life  forced  on  them, 
and  this  creates  an  intense  depression  and  exhaustion  for 


50  INEBRIETY. 

which  spirits  brings  the  most  ready  relief.  In  this  there 
seems  to  be  evident  a  very  close  connection  between  wide- 
spread disasters  and  high  tides  of  alcoholic  drinking.  An 
example  like  the  following  is  not  unfrequently  seen.  In 
a  certain  town,  without  any  special  reason,  an  unusual 
number  of  saloons  were  opened  and  the  sale  of  spirits  in- 
creased to  great  proportions  so  that  crimes,  pauperism 
and  loss  became  very  prominent.  Public  sentiment  re- 
acted and  a  great  temperance  wave  followed,  which  ended 
in  driving  out  the  saloons  and  a  vote  of  no-license.  A  few 
years  later,  the  failure  of  a  very  large  mill  and  greatly 
depressed  financial  conditions  was  followed  by  the  reap- 
pearance of  saloons  with  crime,  pauperism  and  misery, 
and  again  a  temperance  wave  swept  over  the  town,  and 
once  more  no-license  and  no  saloons  prevailed.  There  is 
in  this  a  distinct  intimation  of  some  great  psychological 
movement  sweeping  over  cities  and  states  and  controlling 
the  rise  and  fall  of  inebriety.  With  farther  study  and 
more  exact  knowledge,  this  subject  of  psychical  wave 
forces  controlling  inebriety,  opens  up  a  most  fascinating 
field  for  future  discovery.  Thus  the  temperance  revivals 
and  crusades  and  social  and  political  efforts  to  stamp  out 
and  diminish  inebriety  are  not  chance  and  accidental  oc- 
currences, but  evidences  of  some  great  laws  which  regulate 
and  control  the  evolutionary  movements  of  the  race. 

While  there  is  much  conflicting  evidence  in  regard  to 
the  extent  of  inebriety  in  America,  there  are  many  rea- 
sons for  believing  that  it  is  slowly  diminishing.  The  sale 
of  beer  is  increasing,  while  that  of  strong  drink  in  some 
sections  is  less  or  remains  about  the  same.  There  can  be 
no  question  that  there  is  a  sharp  decline  in  the  use  of 
spirits  among  native  born  Americans.  The  use  of  alcohol 
among  American  women  is  also  disputed,  some  asserting 
that  it  is  increasing,  others  that  it  is  growing  less.  While 
it  is  more  concealed  in  this  country,  and  is  less  apparent, 


INEBRIETY  IN  AMERICA  AND  ITS  PECULIARITIES.      51 

some  authors  have  asserted  that  the  demand  for  narcotics 
among  American  women  is  increasing,  but  this  fact  is  only 
sustained  by  some  local  statistics,  and  in  all  probability 
does  not  apply  to  the  masses.  The  general  fact,  which 
all  authorities  concede  to  be  correct,  is  that  the  use  of 
spirits  is  gradually  declining  and  that  social  drinking  is 
less  prominent. 

Persons  of  foreign  birth  still  cling  to  the  old  customs 
of  beer  and  spirits  at  meal  time,  and  a  certain  class  of 
imitators,  who  believe  that  wine  and  spirits  are  luxuries 
continue  their  use  without  any  special  reason.  It  is  evi- 
dent that  the  same  general  causes  which  regulate  the  use 
of  spirits  among  men  in  active  life  are  influential  with 
women,  with  this  addition,  they  are  more  sensitive  to  the 
effects  of  wine  and  are  more  active  to  escape  from  its  in- 
juries. Narcotics  and  substitutes  for  spirits  are  undoubt- 
edly in  great  demand  in  certain  sections,  but  it  is  doubtful 
if  this  demand  is  greater  among  women  than  men.  Care- 
ful studies  of  persons  in  particular  sections  of  the  coun- 
try show  a  marked  diminution  in  the  use  of  spirits  or 
narcotics  for  any  purpose,  and  this  undoubtedly  is  true 
in  a  general  way  for  the  entire  country. 

The  psychic  influences  which  seem  to  be  active  in  the 
spread  of  inebriety  and  its  control  have  been  the  subject 
of  many  essays.  Dr.  Bowditch,  of  Boston,  Mass.,  called 
attention  to  an  apparent  isothermal  belt  crossing  the  con- 
tinent marking  the  center  of  the  most  active  use  of  spir- 
its. From  this  point  each  way  there  appeared  to  be  a 
decline  in  the  use  of  spirits.  A  later  study  indicated 
other  causes  than  that  of  climate  and  pointed  to  some 
psychic  current  and  wave,  starting  from  certain  centers 
and  spreading  along  lines  difficult  to  trace,  but  apparently 
responsible  for  the  excess  and  diminution  of  spirits.  An- 
other author  asserted  very  prominently  that  the  presence 
of  inebriety  in  the  community  was  always  followed  by  a 


52  INEBRIETY. 

certain  immunity  in  the  next  generation.  Several  authors 
have  endorsed  Dr.  Reid's  studies  of  heredity  and  conclude 
that  immunity  in  families  and  communities  and  nations 
always  follows  the  excessive  use  of  spirits.  More  extend- 
ed studies  of  the  facts  show  that  these  theories  are  not 
well  supported  and  that  always  in  the  next  generation  the 
lowered  vitality,  increase  of  disease  and  mortality  and 
hypersensitiveness  to  spirits  is  most  commonly  noted.  In 
another  chapter  this  subject  will  be  presented  in  some  de- 
tail. 

It  has  been  pointed  out  that  the  extreme  of  heat  and 
cold  are  active  as  causes  in  the  production  of  inebriety. 
Several  essays  have  been  written  on  this  topic,  but  the 
conclusions  are  not  in  accord  with  the  general  facts  that 
are  known.  While  it  is  true  that  stronger  spirits  are 
sought  for  in  the  cold  climates  and  lighter  wines  in  the 
warm  belts  of  the  country,  the  effects  of  all  these  drinks 
are  practically  the  same,  irrespective  of  heat  or  cold. 

The  consumption  of  tobacco  has  furnished  themes  for 
many  studies,  showing  a  connection  between  it  and  the 
growth  of  inebriety.  Many  startling  examples  have  been 
presented,  but  the  facts  are  not  numerous  enough,  or 
sufficiently  studied  to  support  any  positive  conclusions. 

There  can  be  no  doubt  that  the  largest  factor  deter- 
mining the  peculiarity  of  American  inebriety  is  the  con- 
tagious excitement  and  continuous  nerve  strain,  which 
pervades  all  societies  and  business  circles,  and  the  result- 
ant exhaustion  which  follows,  is  influential  in  the  develop- 
ment and  duration  of  this  malady.  Thus  the  average 
American  in  all  circles  is  restless  and  always  seeking  new 
conditions  of  life,  changing  incessantly  with  every  new 
prospect  of  gain ;  business  and  work  of  all  kinds  are  done 
under  a  pressure  and  excitement  that  gives  little  chance 
for  proper  nerve  rest.  The  emigrant  soon  catches  the 
contagion  of  change  and,  if  he  is  a  young  man,  all  his 
habits  of  life  become  keyed  to  the  same  incessant  strain. 


INEBRIETY  IN  AMERICA  AND  ITS  PECULIARITIES.      53 

The  American  inebriate  drinks  at  the  bar,  standing 
up,  and  then  hurries  out.  The  club-house  and  beer- 
garden  have  no  attractions  for  him.  All  attempts  to  form 
beer-gardens  for  working  men  to  sit  down  and  drink  in 
are  failures.  The  pressure  of  business  opposes  it.  There 
is  no  time  to  spend  in  such  places.  If  a  man  wants  beer 
he  takes  it  to  his  home.  The  club-house  is  a  visiting 
place  where  business  and  plans  are  discussed  and  projects 
of  how  to  take  advantage  of  the  present  and  future  and 
not  for  daily  relaxation  and  comfort.  The  saloon  for  the 
poorest  classes  is  practically  the  same  kind  of  place. 
The  patrons  drink  standing,  plan  strikes  or  talk  political 
topics  and  questions  of  profits  and  more  lucrative  work. 

Tobacco,  like  spirits,  is  used  for  its  narcotic  effects. 
Coffee  and  tea  are  taken  in  the  same  impulsive  precipitant 
way.  This  intensity  of  living  calls  for  the  relief  and 
narcotism  of  alcohol,  which  actually  covers  up  the  ex- 
haustion and  draws  on  the  reserve  strength  of  the  body 
and  mind;  thus  the  American  inebriate  is  constantly  dis- 
counting his  future  vigor  and  strength,  and  lives  on  the 
borders  of  physical  and  mental  bankruptcy.  Often  he 
realizes  this  in  the  uncertain  changeable  way  in  which 
different  varieties  of  spirits  are  used.  For  a  time  he  is  a 
moderate  drinker.  Then  abstains  and  drinks  at  intervals, 
then  uses  drugs  for  substitutes,  going  from  one  to  the 
other  in  a  vain  attempt  to  escape  the  inevitable  effects. 
As  a  total  abstainer  and  promoter  of  temperance  he  is 
very  emphatic  and  pronounced ;  as  an  advocate  of  spirits 
he  is  equally  dogmatic.  The  tendency  to  go  to  extremes 
and  settle  the  whole  matter  at  once,  in  excess  of  effort  of 
mind  and  body,  is  very  apparent. 

The  average  American  who  begins  to  fail  in  strength 
at  the  summit  of  his  success,  goes  off  to  Europe  in  quest 
of  health,  claiming  to  be  overworked  and  needing  rest  and 
change.  He  rushes  from  place  to  place,  becoming  more 
fatigued  than  at  home,  and  finally  returns,  bringing  with 


54  INEBRIETY. 

him  a  new  conception  of  the  medicinal  value  of  wine  at 
meals.  Later  he  is  found  drinking  to  excess,  and  so  dies. 
The  young  man  or  woman  who,  from  residence  abroad, 
gets  the  same  conception  of  the  value  of  wines  and  liquors 
at  meals,  or  as  tonics,  finds  after  a  few  years  of  trial  in 
this  country,  a  degree  of  invalidism  and  incapacity, 
which  he  or  she  rarely  attributes  to  the  true  cause.  These 
are  common  examples  which  show  that  inebriety  in  Amer- 
ica is  a  mania,  a  form  of  paranoia  and  degeneration  that 
differs  from  that  in  other  countries.  The  causes  are  very 
complex  and  include  everything  which  stimulates  brain 
and  nerve  activity  to  its  highest  point  of  endurance. 

In  efforts  to  check  and  cure  inebriety  the  same  in- 
cessant movement  is  apparent.  As  an  inmate  of  the 
hospital,  he  calls  for  continuous  efforts  to  do  something, 
forgetting  that  rest  is  nature's  best  assistant;  when  sick 
at  home  different  remedies  and  measures  for  relief  are 
demanded,  with  a  morbid  impulse  that  indicates  grave 
central  disturbances.  Recovery  sometimes  takes  place  in 
the  same  extraordinary,  unusual  way.  Quacks  that 
promise  cure  by  mysterious  drugs  are  popular  at  once, 
because  of  the  excessive  credulity  of  the  victim.  Patent 
medicines  and  drugs  containing  narcotics  become  popular 
in  proportion,  as  they  quiet  the  nerve  irritation  and 
exhaustion  of  the  victim. 

It  is  evident,  from  a  variety  of  facts,  that  the  use  of 
spirits  and  drugs  can  not  be  taken  safely  in  America, 
especially  in  our  present  revolutionary  stage  of  society 
and  its  evolutions. 

In  business  circles  this  fact  is  becoming  important 
through  the  increasing  efforts  to  drive  out  the  use  of 
spirits  as  a  beverage ;  and  also  the  recognition  of  the 
business  incapacity  of  users  of  spirits,  their  susceptibility 
to  disease,  and  their  incompetency  to  endure  the  strains 
of  business  life. 


CHAPTER  VI. 
GENERAL  SYMPTOMOLOGY  AND  DEVELOPMENT. 

Synopsis. —  Three  distinct  periods  in  the  symptomology.  De- 
scription of  each  period.  In  the  third  period  patients  "come  under 
observation.  Their  symptoms  are  so  prominent.  Efforts  are  made 
to  abstain,  or  limit  the  use  of  spirits.  The  first  stage  one  of  great 
indifference.  The  last  stage  marked  by  delirium  and  delusions. 
Insane  reasonings.  Exaggerated  egoisms.  Persons  with  good 
reasoning  on  other  matters,  are  literally  insane  concerning  the 
use  and  effects  of  spirits.  So-called  moderate  drinker  is  incapable 
of  judging  of  himself.  Examples.  Persons  living  lives  of  great 
excitement  never  realize  their  danger.  Moral  palsy  common  in 
this  stage.  Defects  of  the  senses  very  noted.  Emotional  depres- 
sions common.  Muscular  control  enfeebled.  Beer  drinkers  have 
nutritive  degenerations  with  enlarged  hearts  and  fibrinous  de- 
posits. Muscle  workers  have  low  vitality  and  are  able  to  adapt 
themselves  to  changes.  Active  brain  workers  have  peculiar 
symptoms,  particularly  of  confusion  of  purpose  and  object  in  life. 
Many  of  these  persons  die  from  other  acute  diseases.  The  face 
registers  these  changes.  Physical  defects.  Whitened  hair. 
Blanched  face.  Feeble  muscular  power.  The  display  of  brutal 
qualities  when  drinking.  Wide  variations  of  character.  Skepti- 
cism and  pleasure  in  condemning.  Destructive  criticism.  A  hint 
of  an  alcoholic  mind.  Examples.  General  considerations. 

The  general  symptomology  of  inebriety  may  be  traced 
and  studied  in  several  distinct  stages.  The  first,  extend- 
ing over  months  and  years,  is  one  of  occasional  and  ir- 
regular use  of  spirits  and  beer.  During  this  period 
spirits  may  be  taken  to  produce  stupor  and  intoxication; 
this  may  be  followed  by  disgust  and  long  periods  of 
abstinence.  Then  spirits  are  used  again  and  the  former 
aversion  does  not  appear.  A  second  stage  is  marked  by 
the  continuous  use  of  spirits  in  small  quantities,  often 
at  meals.  The  patient  justifies  his  use  of  them  as  neces- 
sary and  medicinal,  while  toxic  conditions  may  follow 
they  are  unnoticed,  and  supposed  to  be  accidental.  A 
third  period  begins  with  an  attack  of  delirium,  or  some 
very  unusual  act  or  course  of  conduct  which  alarms  his 

friends.      An  effort  is  then  made  to  either  abstain   alto- 

55 


56  INEBRIETY. 

gether  or  to  limit  the  use  of  spirits  to  a  moderate  quan- 
tity. At  this  time  he  may  come  under  medical  obser- 
vation, and  is  found  to  be  suffering  from  organic  changes 
with  delusional  mental  states  concerning  his  condition, 
and  relation  to  others.  The  first  and  third  periods  are 
very  often  closely  related.  In  the  second  stage,  a  pre- 
liminary period  of  wine  and  beer  drinking  may  continue 
for  a  long  time,  with  only  the  occasional  use  of  spirits, 
which  at  long  intervals  may  culminate  in  acute  intoxica- 
tion and  recovery,  going  back  again  to  beer  or  wine. 
The  first  stage,  in  nearly  all  cases,  is  one  of  great  indif- 
ference to  the  danger  and  possible  ill  effects  from  the 
use  of  spirits.  The  patient  is  always  confident  of  his 
ability  to  stop,  and  considers  his  situation  and  use  of 
spirits  as  largely  due  to  trivial  circumstances  and  con- 
ditions, over  which  he  has  full  power.  In  the  later 
stages  delusional  confidence  in  his  will  power  to  stop  in- 
creases with  the  gravity  of  the  symptoms.  Often  dif- 
ferent forms  of  delirium  and  delusion  growing  out  of  the 
use  of  spirits  are  realities  to  him,  and  are  so  positively 
fixed  in  the  mind  that  they  can  not  be  overcome. 

In  many  instances  the  most  ingenious  reasons  are  given 
to  confirm  and  sustain  his  confidence  in  their  reality,  and 
no  pressure  or  advice  by  friends  can  make  any  impression 
or  indicate  the  real  character  of  his  mental  condition. 
Persons  with  good  judgment  on  all  other  matters  will  have 
the  most  delusional  impression  of  their  own  conditions,  and 
assert  with  great  confidence  that  outside  influences  and 
undue  anxiety  and  annoyance  by  friends  are  active  causes 
of  his  present  stage.  This  peculiar  egotism  is  a  species 
of  general  paralysis,  particularly  of*  the  higher  brain 
centers.  It  literally  means  a  progressive  anesthesia  of 
certain  areas  of  the  brain  with  unconsciousness  of  the 
real  condition. 


GENERAL  SYMPTOMOLOGY  AND  DEVELOPMENT.     57 

The  moderate  user  of  spirits,  or  one  who  takes  a 
stated  amount  regularly  for  years,  has  a  very  imperfect 
conception  of  his  condition  and  little  ability  to  judge  of 
himself.  The  use  of  alcohol  to  great  excess  is  followed 
by  a  demented  condition  in  which  the  brain  is  bewildered 
and  unable  to  act  from  any  clear,  rational  point  of  view. 
Often  a  moderate  drinker  will  use  spirits  to  great  excess 
and  have  an  attack  of  delirium,  and  recover  and  with  it  a 
decreasing  consciousness  of  what  has  taken  place  and 
of  the  feebleness  of  his  brain  power. 

In  a  certain  number  of  cases  where  spirits  have  been 
taken  at  very  long  intervals  in  great  moderation,  and 
the  person  claims  to  be  practically  a  total  abstainer,  sud- 
denly he  begins  to  use  spirits  to  excess.  A  progressive 
paralysis,  with  a  rapid  decline  in  both  the  mental  and 
organic  activities  appears.  The  following  is  an  example. 
An  active  business  man  who,  at  long  intervals,  had  taken 
wine  in  moderation  at  banquets  and  never  for  any  toxic 
action,  and  was  considered  a  temperate  man,  began  to 
drink  to  excess.  He  became  intoxicated  every  night,  vis- 
ited clubs  and  saloons,  giving  no  explanation,  or  making 
no  effort  to  abstain.  This  continued  for  a  few  months, 
when  he  was  finally  found  dead  in  his  bed.  Cases  be- 
longing to  this  class,  although  not  so  prominent,  have 
frequently  been  noted,  and  the  physical  effect  of  the 
drink  craze  is  beyond  all  question. 

Many  persons  with  highly  developed  nervous  system, 
living  lives  of  great  stress  and  strain,  after  some  par- 
ticular shock  or  disease  begin  to  use  spirits.  With  this  a 
special  moral  palsy  or  general  failure  of  the  ethical 
recognition  of  duty,  obligation  and  consciousness  of  right 
and  wrong  appears.  Delusional  conditions  and  perver- 
sions of  reasoning  are  early  symptoms,  and  with  these, 
marked  defects  of  character,  which  constantly  increase, 
are  noticed. 


58  INEBRIETY. 

In  other  persons  sensory  defects  are  among  the  most 
prominent  early  symptoms. 

The  defects  of  the  eye  and  the  constant  change  of 
glasses ;  the  faults  of  hearing,  taste,  touch  and  in  the 
recognition  of  odors,  are  symptoms  of  palsy  of  the 
senses  which  are  recognized  by  friends,  and  are  among 
the  first  symptoms.  In  other  persons  melancholia  and 
unusual  depression,  without  any  apparent  cause  or  sus- 
picion of  wrong-doing,  are  noted  first.  Other  persons 
show  feebleness  of  the  muscular  centers  and  power  of 
control.  Such  persons  stumble  easily,  can  not  hold  things 
in  their  hands,  are  easily  exhausted  and  seem  to  have 
some  form  of  muscular  palsy. 

Another  class  exhibit  early  derangements  of  nutrition, 
particularly  marked  digestive  troubles.  Foods  and  liquids 
are  used  impulsively,  and  produce  great  disturbance. 
Later  local  inflammations  and  various  functional  disorders 
occur.  Beer  drinkers  are  often  subject  to  these  neutra- 
tive  degenerations  and  the  excessive  anxiety  to  find  rem- 
edies for  their  relief  and  the  obscurity  and  complexity 
of  such  disturbances  point  clearly  to  alcohol  as  a  spe- 
cial cause. 

The  vigor  of  the  brain  is  very  early  impaired  in  such 
cases,  and  its  faulty  activities  reflect  the  poisoned  and 
paralyzed  conditions.  The  muscle  workers  who  use  beer 
and  spirits  regularly  are  particularly  degenerate,  and 
physically  have  very  low  vitality  are  unable  to  adapt 
themselves  to  changes  of  environment,  and  succumb 
quickly  to  acute  inflammation  from  any  cause.  Active 
brain  workers  who  use  spirits  steadily,  have  many  symp- 
toms that  are  peculiar.  Thus  the  delusion  of  exaltation 
and  egoism  is  prominent,  and  the  unusual  optimism  con- 
cerning themselves  is  very  marked.  Many  of  these  per- 
sons have  symptoms  of  paresis,  and  it  is  difficult  to 


GENERAL  SYMPTOMOLOGY  AND  DEVELOPMENT.      59 

determine  how  far  alcohol  is  the  active  exciting  cause, 
or  the  desire  for  it  a  symptom  of  some  previous  degenera- 
tion which  is  developing.  Many  of  these  obscure  cases 
have  been  the  subjects  of  great  confusion  in  the  diagnosis 
and  treatment,  but  in  all  there  is  a  continuous  anesthesia 
and  paralysis  of  both  the  brain  and  organism.  Some  of 
these  cases  go  on  to  pronounced  paresis.  Many  of  them 
die  of  intercurrent  disease  and  are  not  considered  inebri- 
ates, but  the  excessive  use  of  spirits  is  a  marked  symptom 
of  the  history  of  the  case. 

In  other  cases,  the  eyes  and  face  register  the  degenera- 
tions more  clearly  than  any  other  part  of  the  body. 
The  voice  is  another  symptom  of  the  palsy  from  the 
use  of  spirits.  Many  authors  have  referred  to  the 
symptoms  of  premature  old  age  in  comparatively  young 
men.  The  hair  becomes  white.  The  face  is  blanched  or 
congested,  the  eye  is  dull  and  watery,  the  speech  is  slow 
and  broken,  and  the  tones  are  nasal  and  feeble.  The 
muscular  powers  are  diminished.  Nutrition  is  disturbed, 
and  such  persons  are  irritable,  stupid  and  childish.  These 
are  all  pronounced  symptoms  of  inebriety. 

The  oft-repeated  statement  that  the  action  of  alcohol 
reveals  the  real  man  and  his  purposes  is  not  true.  The 
sudden  display  of  coarseness  and  brutality  in  one  who 
when  sober  is  genteel  and  kindly,  is  not  uncovering  the 
predominant  traits  of  character.  It  is  simply  putting 
to  sleep  the  higher  faculties  and  allowing  the  lower  ones 
to  control.  Instances  are  noted  of  persons  who  become 
excessively  religious  when  under  the  influence  of  spirits, 
and  on  recovery  this  feeling  disappears.  Persons  who 
are  selfish  and  grasping,  when  under  the  influence  of 
spirits,  are  often  most  kind  and  generous.  Others  are 
extremely  skeptical,  pessimistic  and  bitter  while  drinking, 
and  when  sober  are  credulous  and  optimistic  in  the  highest 
degree. 


60  INEBRIETY. 

A  noted  writer  whose  stories  have  been  widely  read, 
when  under  the  influence  of  spirits  described  the  suffer- 
ings and  miseries  of  persons  in  the  most  wretched  con- 
ditions of  life  with  great  minuteness ;  when  sober  such 
descriptions  are  rarely  attempted,  and  always  treated  with 
brevity.  Another  symptom,  peculiar  to  the  so-called 
moderate  drinker,  and  particularly  so  to  the  one  who 
drinks  steadily  both  beer  and  strong  spirits,  is  the  unrea- 
sonable criticism  and  intense  pleasure  in  condemning  and 
discovering  bad  motives  for  all  sorts  of  conduct.  This 
is  a  kind  of  pessimism  that  takes  intense  pleasure  in 
destroying  and  retarding  everything  considered  sacred  or 
correct  by  others.  It  is  asserted  that  bitter  criticisms, 
which  are  destructive  and  unreasonable,  are  indications 
of  an  alcoholic  brain.  This  is  confirmed  by  many  striking 
instances.  Very  interesting  studies  are  to  be  made  along 
this  line.  In  the  future  pages  this  idea  will  be 
brought  out. 


CHAPTER  VII. 

PECULIARITIES  OF  CONDUCT  AND  THOUGHT  TRACE- 
ABLE TO  INEBRIETY. 

.Synopsis. —  Inaccuracy,  mistakes  and  failures  prominent  symp- 
toms. Carelessness.  Childish  explanations  and  inability  to  adapt 
oneself  to  the  condition  symptomatic.  Examples.  Bankrupts, 
previously  honest  and  careful  business  men.  Traceable  to  the 
use  of  spirits.  Sensory  derangement  and  defects  of  the  reason 
more  common  in  this  country  than  elsewhere  among  inebriates. 
Emotional  changes  significant.  Great  variations  in  style  and 
clearness  in  literary  work,  point  to  alcohol,  insomnia  and  nervous- 
ness, catarrhal  troubles  and  other  conditions  traceable  to  this 
cause.  Neuritis  a  common  sequel.  Dr.  Kerr's  drama  of  three 
acts,  in  the  history  of  inebriety.  Great  changes  in  muscular 
output.  Extreme  skepticism  of  the  honor  of  others.  Imperfect 
work,  faulty  expressions  and  neglect  of  important  matters  com- 
mon symptoms.  Delirium  common  in  so-called  moderate  drinkers. 
Examples  of  concealed  drinking.  Malaria  used  to  describe  it. 
Many  symptoms  complex,  but  all  follow  distinct  lines  which  may 
be  studied  and  understood. 

Another  symptom  is  the  subject  of  considerable  com- 
ment, and  noted  in  the  carelessness,  inaccuracy  and  in- 
creasing mistakes  and  errors  in  thought  and  conduct. 
Men  and  women  previously  exact  and  accurate  in  their 
use  of  words,  careful  in  recognition  of  duty,  and  of 
scrupulous  conduct,  show  great  changes  in  carelessness 
and  failures  to  maintain  their  former  character  in  conduct 
and  thought.  Thus  persons  engaged  in  work  requiring  ac- 
curacy and  strict  observance  of  details  show  this  very 
clearly.  For  this  reason  banking,  railroading  and  engi- 
neering projects  reveal  the  alcoholic  brain  in  the  mistakes 
of  the  persons  who  are  doing  the  work. 

Many  supposed  temperate  men  exhibit  this  peculiar 
symptom  of  carelessness  and  inaccuracy  that  is  traced  to 
their  use  of  spirits.  They  are  discharged,  and  soon 
after  their  drinking  becomes  prominent.  The  explana- 
tion given  is  the  depression  from  loss  of  position  and 

61 


62  INEBRIETY. 

supposed  persecution  by  friends.  In  reality,  they  have 
been  concealed  inebriates,  and  the  change  of  environment 
and  position  reveal  the  real  condition.  An  example  which 
was  the  subject  of  much  notoriety  occurred  in  a  clergy- 
man, whose  faults  of  memory,  inaccuracy  of  statements 
and  neglect  of  duty  became  notorious.  The  physician 
diagnosed  it  as  brain  fatigue  and  neurasthenia,  and  sent 
him  on  a  tour  of  travel.  This  ended  in  pronounced  in- 
ebriety and  death  a  few  months  later.  The  question  in 
dispute  was  the  diagnosis  concerning  the  possibility  of 
his  concealed  use  of  spirits  being  an  exciting  or  pre- 
disposing cause,  or  a  symptom  of  the  final  collapse.  In 
another  instance  a  banker  exhibited  very  unusual  and 
careless  conduct  in  his  affairs.  The  medical  man  failed 
to  recognize  the  alcoholic  causation,  and  ordered  tinc- 
tures and  wines  as  tonics  and  stimulants.  Within  a  few 
weeks  he  became  wildly  intoxicated  and  died  a  few 
months  later. 

Many  instances  have  been  noted  of  bold  and  reckless 
speculation  by  men  previously  conservative,  followed  by 
bankruptcy,  the  excessive  use  of  spirits  and  death.  These 
cases  are  so  numerous  that  mercantile  agencies  rate  very 
low  persons  who  are  known  to  be  moderate  or  occasional 
drinkers  of  spirits.  Experience  shows  that  such  persons 
become  bankrupts  more  frequently,  and  are  more  uncer- 
tain in  their  health  and  vigor.  It  is  stated  that  these 
defects,  particularly  of  the  senses  and  reason,  are  more 
pronounced  in  this  country  than  elsewhere.  As  a  sum- 
mary, it  may  be  stated  that  the  absence  of  caution  and  a 
degree  of  recklessness  in  the  common  affairs  of  life,  par- 
ticularly in  persons  previously  conservative  and  sane,  is  a 
very  significant  hint  of  alcoholic  anaesthesia ;  also  that 
unusual  buoyancy  and  unreasonable  faith  in  his  own 
capacity,  and  credulity  of  the  statement  of  others,  is  an 
additional  confirmation.  Again,  emotional  changes  from 


CONDUCT  AND  THOUGHT.  63 

boasting  garrulity  to  timidity  and  stupor  are  additional 
symptoms. 

Many  persons  exhibit  the  effects  of  alcohol  in  a  bright, 
flashing  eye  and  loud  bronchial  voice,  also  assertiveness 
and  absence  of  dignity  bordering  on  the  offensive.  Pub- 
lic speakers  exhibit  these  symptoms,  and  the  critical  stu- 
dent discovers  that  they  have  used  spirits  to  give  them 
additional  force  and  power.  In  reality,  the  effects  are 
just  the  opposite.  The  clearness  of  the  thought  is  ob- 
scured and  the  consciousness  of  the  effect  of  his  language 
and  manner  is  diminished.  A  revivalist  whose  dogmatic, 
assertive  manner  and  delirious  expressions  attracted  great 
attention,  would  have  periods  of  great  depression  and 
exhaustion  after  his  platform  work.  A  sympathetic 
doctor  prescribed  spirits  as  a  tonic,  and  very  soon  after- 
wards he  retired  to  a  hospital  to  be  treated  for  brain 
fatigue.  The  actual  condition  was  one  of  inebriety,  and 
the  symptoms  were  the  delirium  of  intoxication. 

In  some  persons  the  unusual  buoyancy  following  the 
use  of  alcohol  manifests  itself  in  word  delirium.  Such 
persons  tell  or  write  stories  that  are  notorious  for  their 
detailed  descriptions,  but  exhibit  faults  of  plan  or  pur- 
pose. A  number  of  literary  men  use  spirits  to  give 
fluency  and  supposed  clearness  to  their  work.  They 
rarely  realize  the  unevenness  and  the  purposeless  trend 
of  the  thought  they  express ;  brilliant  sentences,  high- 
sounding  figures  of  speech  that  express  nothing  and 
lead  nowhere.  Many  books  written  by  persons  when 
under  the  influence  of  alcohol,  indicate  the  mental  con- 
dition and  the  alternate  exhilaration  and  depression  due 
to  spirits.  The  plot  of  a  book  may  be  very  clear  at 
the  beginning,  but  when  drawn  out  by  an  alcoholic  mind 
it  will  vary  widely  from  the  original. 

Insomnia  is  often  a  very  significant  symptom,  and 
profound  debility,  resembling  collapse  coming  on  sud- 


64  INEBRIETY. 

denly,  indicate  toxic  conditions,  of  which  alcohol  is  a 
common  cause. 

There  are  evidently  less  congested  and  red  faces 
among  inebriates  in  America  than  among  foreigners. 
Many  inebriates  have  a  blanched  appearance.  The  action 
of  alcohol  after  a  brief  period  of  flushing  the  facial 
arteries  and  veins,  produce  constriction  and  marked  pallor. 
The  muscles  become  paralyzed  and  a  listless,  dull  expres- 
sion follows.  The  emotional  changes  do  not  show  in  the 
play  of  facial  muscles,  and  the  voice  becomes  bronchial 
from  the  congestion  of  the  mucus  membrane. 

Frequently  for  the  catarrhal  states  that  follow  from 
the  use  of  spirits,  cocaine  is  prescribed  and  a  new  addic- 
tion is  provoked.  This  remedy  gives  new  buoyancy,  and 
not  unfrequently  spirits  are  abandoned,  but  this  is  of 
short  duration.  The  constant  drinker  always  suffers 
from  changes  in  the  membranes  of  the  nose  and  throat. 
This  in  vocalists  and  professional  men  who  use  the  voice 
freely,  develops  into  aphonia.  Obstinate  bronchial  and 
catarrhal  troubles  are  effects  from  alcohol  in  many  in- 
stances. When  the  spirits  are  taken  away  the  disap- 
pearance of  these  diseases  is  very  marked. 

So-called  rheumatic  pains  of  the  lower  extremities, 
with  cramps  and  numbness,  are  always  significant  symp- 
toms of  an  alcoholic  origin.  In  the  so-called  moderate 
and  constant  drinkers,  it  is  clearly  neuritis  of  a  toxic 
origin.  In  many  cases  this  is  not  recognized,  and  patients 
supposed  to  have  acute  rheumatism,  particularly  marked 
by  palsy  of  the  lower  extremities,  are  given  alcohol  as  a 
remedy.  In  many  instances  the  toxic  effects  of  alcohol 
seem  to  concentrate  most  prominently  on  the  sensory  and 
motor  nerves  of  the  extremities. 

The  late  Dr.  Kerr  divided  the  symptoms  of  inebriety 
into  what  he  called  a  drama  of  three  acts.  The  first 
was  that  of  exhilaration,  in  which  the  face  was  flushed, 


CONDUCT  AND  THOUGHT.  65 

the  eye  was  flashing,  the  heart  beat  rapidly  and  a  feeling 
of  extreme  optimism  and  satisfaction  gave  the  patient 
the  appearance  of  new  vigor  and  health.  The  second 
stage,  the  flushed  face  became  more  intense  and  the  eye 
became  duller  and  the  previous  excitement  passed  away. 
The  imagination  and  impulsiveness  had  dwindled  away. 
The  thoughts  that  were  formerly  clear  became  confused, 
and  the  posing  for  effect  passed  off.  The  former  bold- 
ness disappeared.  A  complete  change  in  conduct  and 
appearance  is  noted.  If  his  work  is  automatic  it  will 
be  slower  and  more  mechanical.  A  marked  depression 
and  departure  from  the  normal  is  evident.  If  in  the  first 
stage  he  was  unusually  confidential  and  credulous,  he  now 
becomes  suspicious  and  hesitates.  Finally,  the  last  stage 
of  the  drama  is  marked  by  sleep,  stupor  and  general  un- 
consciousness of  his  condition  and  the  surroundings.  This 
is  practically  a  form  of  progressive  paralysis,  beginning 
with  excitement  and  general  disturbance  of  the  emotional 
system,  extending  to  the  reason  and  conduct,  and  finally 
ending  in  stupor  and  coma.  In  many  persons  these  three 
stages  are  clear  and  well  defined.  In  others  they  are 
somewhat  obscure.  The  first  stage  of  exhilaration  may 
be  very  prominent  or  almost  entirely  absent,  as  far  as 
symptoms  would  indicate,  but  the  second  and  third  stages 
are  always  present.  In  persons  who  have  become  chronic 
the  period  of  exhilaration  is  brief  and  rarely  noticed,  but 
the  languor,  comfort,  rest,  and  finally  sleep,  are  always 
present. 

Persons  engaged  in  active  work  use  spirits  to  give 
steadiness,  and  put  them  in  the  second  stage  with  appar- 
ent power  of  control.  The  anaesthesia  of  this  stage  is  the 
one  that  approaches  the  ideal  in  the  estimation  of  the 
victim.  The  first  stage  of  excitement  and  the  last  stage 
of  stupor  are  conditions  to  be  avoided. 


66  INEBRIETY. 

The  supposed  effect  of  alcohol  to  give  additional  force 
and  power  is  the  most  delusive.  Any  work  done  in  this 
stage  is  markedly  imperfect  and  faulty,  and  this  is  noto- 
rious in  every  department  in  business  and  social  life. 
This  second  stage  is  prominent  for  delusions  that  are 
more  or  less  peculiar,  thus  excessive  egotism  and  extreme 
confidence  in  capacity  to  meet  every  emergncy  of  the 
present  is  common. 

Another  delusion  is  that  of  skepticism  of  the  honor  of 
others,  and  belief  of  the  infidelity  and  treachery  of  his 
family  and  associates.  This  later  is  so  marked  as  to  be 
regarded  as  almost  pathognomonic.  It  is  the  materializa- 
tion of  this  delusion,  and  the  effort  to  correct  the  sup- 
posed wrong  which  often  ends  in  homicide.  The  inebriate 
who  believes  his  wife  and  other  members  of  his  family 
untrue,  and  that  they  are  plotting  his  ruin,  has  reached 
a  chronic  stage  which  demands  prompt  recognition  to 
avert,  and,  if  neglected,  will  be  followed  by  crime. 

Another  delusion  is  that  of  wealth  and  ability  to  influ- 
ence and  command  capital  and  control  others.  This 
should  be  regarded  as  a  paretic  symptom,  and  very  often 
terminates  in  general  paralysis. 

Another  delusion  or  symptom  that  is  very  common  is 
that  of  ability  to  conceal  the  use  of  alcohol  and  explain 
the  symptoms  as  due  to  other  causes.  They  never  ac- 
knowledge what  is  so  apparent  to  others,  and  can  never 
be  persuaded  that  their  use  of  spirits  is  known,  or  in 
any  way  impairs  or  diminishes  their  strength  and  vigor. 
This  particular  delusion  is  seen  in  certain  circles  where 
persons  go  away  and  remain  secluded  for  an  indefinite 
period,  and  then  return,  giving  full  explanations  of  what 
they  have  done.  Many  instances  like  the  following  have 
greatly  puzzled  both  the  family  and  the  physician.  A 
lawyer  who  goes  to  Europe  every  year  for  rest  will  dis- 


CONDUCT  AND  THOUGHT.  67 

appear  from  London  for  one  or  two  weeks,  then  return 
with  voluminous  explanations  of  his  absence.  He  will 
appear  pale  and  nervous  and  much  weakened.  In  another 
instance  an  active  man  goes  on  what  appears  to  be  a 
hunting  tour,  then  disappears  from  all  observation.  He 
returns  with  the  same  voluble  explanations  and  debili- 
tated appearance. 

Another  significant  symptom  has  been  noted  in  the 
sudden  aging  and  premature  senility  of  active  business 
men,  thus  within  a  brief  time  and  without  any  special 
causes,  the  hair  becomes  white,  the  face  blanched,  the 
eyes  watery,  the  muscles  trembly,  and  the  mind  becomes 
feeble  and  uncertain.  Such  persons  are  known  to  be 
moderate  drinkers,  and  perhaps  have  periods  of  secretive 
visits  to  the  country  or  elsewhere  for  the  restoration  of 
health.  The  diagnosis  of  exhaustion  and  the  prescrip- 
tion of  spirits  and  drugs  always  precipitates  the  fatality 
of  such  cases. 

It  has  been  observed  that  many  so-called  moderate 
drinkers  are  extremely  susceptible  to  delirium,  which  ap- 
parently breaks  out  from  the  slightest  causes.  Thus  a 
blow  on  the  head,  a  fall,  or  some  sort  of  a  shock  or  fit 
of  anger  develops  delirium.  In  common  language,  the 
man  is  considered  crazy  in  his  reason  and  conduct,  but 
the  early  recovery  fails  to  sustain  the  theory.  Such  per- 
sons very  soon  develop  neurotic  disease,  in  which  the 
excessive  use  of  spirits  is  a  very  pronounced  symptom. 

Another  fact  should  be  recognized  in  persons  who  are 
known  as  moderate  drinkers,  namely,  that  of  sudden  ex- 
treme prostration  and  exhaustion  without  any  sufficient 
cause. 

These  unusual  collapses  may  often  be  the  result  of 
concealed  use  of  spirits,  and  strangely  are  treated  by 
spirits  as  a  stimulant.  In  some  instances  an  explanation 


68  INEBRIETY. 

is  given  that  this  condition  is  due  to  poor  whisky  and 
inferior  alcohols,  or  to  some  particular  event  of  minor 
importance.  Malaria  is  a  term  used  to  explain  the 
phenomena  of  exhaustion  that  is  clearly  due  to  the 
toxaemias  from  spirits. 

Persons  who  have  long  before  suffered  from  malarious 
fever,  delude  themselves  with  the  idea  that  their  present 
condition  is  due  to  some  entailment  of  the  former  condi- 
tion, and  not  to  the  secret  or  open  use  of  spirits.  Many 
persons  who  use  spirits  have  profound  toxic  stages  marked 
by  chills  and  fever.  In  one  instance  a  man  of  unusual 
ability  and  strength,  after  a  period  of  intense  activity 
and  excitement,  suffered  from  what  was  called  malaria. 
The  usual  remedies  of  quinine  was  supplemented  with  hot 
spirits  and  the  case  ended  fatally.  In  another  instance 
profound  nervous  collapse  appeared  in  a  previously  active 
man.  He  was  treated  with  spirits  in  great  excess  and  the 
patient  became  a  chronic  inebriate,  blaming  his  physician 
for  causing  inebriety.  In  reality,  he  was  a  secret  drinker 
before. 

Thus  the  symptoms  and  effects  of  inebriety  are  not 
only  complex  and  variable,  depending  upon  the  person, 
the  surroundings,  the  condition  of  life  and  other  factors 
which  should  be  recognized,  but  is  a  distinct  neurosis  that 
involves  toxicity  and  constitutional  susceptibility. 

Delirium  tremens  will  be  described  in  a  separate  chap- 
ter, but  it  must  be  remembered  that  muttering  delirium 
and  muscular  tremor  are  very  significant  symptoms  of  an 
alcoholic  origin.  A  periodicity  of  collapse  symptoms  and 
unusual  mental  conditions  should  always  suggest  a  pos- 
sible alcoholic  origin.  There  can  be  no  question  that  the 
symptoms  from  the  action  of  alcohol  on  the  body  and 
mind,  cither  in  early  or  later  stages,  follow  distinct  lines 
of  degeneration,  and,  while  complicated,  are  peculiar  and 


CONDUCT  AND  THOUGHT.  69 

stand  alone  in  many  ways.  In  the  later  stages  there  is 
little  question  of  the  meaning  of  these  symptoms,  but  in 
the  early  stages  the  finer  depressions  and  changes  of  char- 
acter, conduct,  reason,  habits  of  work,  ambition  and  pur- 
poses are  all  significant  of  degenerative  processes  which 
should  be  discovered. 


CHAPTER  VIII. 

PERIODIC  INEBRIETY  AND  ITS  SYMPTOMOLOGY. 

Synopsis. —  Great  obscurity  concerning-  the  causes  of  these  con- 
ditions. Found  to  resemble  epilepsy.  Various  theories  which  do 
not  accord  with  the  facts.  Patients  very  emphatic  in  their  ex- 
planation of  the  causes,  also  confidence  of  ability  to  control  them. 
Premonitory  symptoms  very  marked  in  some  cases.  In  others  ob- 
scure. Theories  of  alcohol.  Rythms  in  functional  activities  of 
the  body.  The  word  habit.  Two  forms  of  periodic  drinkers.  One 
with  irregular  free  intervals,  very  common.  The  other  with  reg- 
ular free  intervals.  The  first  impressions  from  the  use  of  alcohol. 
The  future  use  depends  upon  this.  These  impressions  powerful  In 
later  life.  Examples.  Hereditary  tendencies.  Drink  craze  neu- 
tralized by  certain  conditions.  Often  periodic  drinkers  are  highly 
developed  nervous  persons.  Midnight  drinkers.  Club  drinkers. 
Relation  to  pneumonia  and  consumption.  Examples.  Curious 
facts.  Confusing  groups  of  cases.  Difficult  matter  to  form  them 
into  any  connected  whole.  Such  cases  should  be  studied.  The 
subsidence  of  the  drink  craze  is  followed  by  other  neuroses. 
Some  of  them  very  severe.  Examples.  Periodic  drinkers  are  very 
seriously  affected.  The  possibility  of  restoration  not  so  good. 
The  drink  craze  may  subside,  but  the  tendency  of  the  system  to 
take  on  periodic  explosions,  very  marked.  Examples.  Farther 
studies  needed. 

The  man  who  drinks  steadily,  with  apparent  self-con- 
trol, attracts  little  or  no  attention,  but  the  one  who  uses 
spirits  to  great  excess,  then  abstains  for  a  period,  is  more 
noticeable.  There  is  some  mystery  about  this  form  of 
periodic  drinking,  and  the  impression  prevails  that  these 
drink  impulses  are  under  the  control  of  the  victim,  and 
are  literally  moral  lapses  which  he  should  and  could  pre- 
vent. 

The  sudden  cessation  and  total  abstinence  from  all 
use  of  spirits  is  explained  by  the  victim  with  great  exact- 
ness, and  this  is  often  accepted  as  evidence  of  his  will- 
power. 

The    various    theories    offered    in    explanation    of    why 

persons  suddenly  drink  to  excess  and  then  stop  with  equal 

70 


PERIODIC  INEBRIETY  AND  ITS  SYMPTOMOLOGY.         71 

abruptness,  are  very  numerous  among  the  victims,  and 
are  accepted  by  the  public  as  accurate  descriptions. 

When  the  phenomena  of  these  attacks  are  studied  scien- 
tifically, they  are  found  to  resemble  those  of  epilepsy 
and  other  convulsive  explosions  of  nerve  energy,  with 
distinct  physical  causes  and  conditions  not  under  the  con- 
trol of  the  will.  The  assertions  of  free  will  and  ability 
to  control  the  drink  impulse  and  to  stop  at  any  mo- 
ment, are  not  confirmed  by  the  repeated  attacks,  hence  the 
inference  that  there  are  other  causes  unknown  in  the 
production  of  these  paroxysms.  Theories  offered  in  ex- 
planation do  not  explain  the  condition,  and  are  con- 
tradicted by  the  facts. 

Careful  studies  of  persons  subject  to  these  drink  storms 
indicate  distinct  physical  and  psychical  strains  that  have 
some  connection,  and  precede  the  outbreak,  and,  in  some 
instances,  they  are  distinct  premonitions  of  the  drink 
excesses. 

In  some  cases  the  patient  is  unconscious  of  the  sig- 
nificance of  these  physical  and  mental  perturbations  pre- 
ceding the  use  of  spirits.  In  others,  he  is  clearly  conscious 
of  the  coming  drink  attacks.  In  the  latter  case  he  will 
often  conceal  these  early  symptoms,  or  explain  them  as 
due  to  other  conditions,  and  in  some  instances  make  prep- 
arations and  talk  about  drinking  and  the  effects  of  al- 
cohol as  if  fully  aware  that  he  is  to  have  a  period  of 
drinking. 

In  a  certain  number  of  instances  persons  have  distinct 
premonitory  symptoms  which  always  precede  the  drink 
attack,  whether  they  are  conscious  of  it  or  not.  If  con- 
scious, they  conceal  it,  but  probably  they  minimize  and 
overlook  the  significance  of  these  oncoming  symptoms. 

One  of  them  is  loss  of  appetite,  and  great  nerve  ten- 
sion, with  irritability  and  unusual  excitement.  Another 


72  INEBRIETY. 

is  gormandizing,  and  inordinate  appetite,  eating  large 
quantities  of  food,  drinking  tea  and  coffee  to  excess,  etc. 
Another  symptom  is  intense  activity  and  prolonged  work, 
neglect  of  rest,  unusual  excitement  and  anxiety  about  his 
work,  family  and  other  surroundings. 

Thus  a  previously  lethargic  man  will  become  intensely 
active,  and  manifest  great  energy,  quite  unusual,  then 
suddenly  drink  to  great  excess.  A  previously  healthy 
man  sleeping  well,  will  have  insomnia  for  a  few  days, 
and  then  begin  to  drink,  or  he  will  show  unusual  anxiety 
of  some  oncoming  serious  disease  and  consult  various 
physicians,  and  then  drink  to  great  excess  and  forget  all 
his  previous  symptoms. 

To  the  friends  these  great  irregularities  of  thought  and 
conduct  are  not  often  recognized  as  premonitory  to  the 
drink  attack.  In  such  cases  there  is  undoubtedly  present 
some  condition  of  hypersesthesia  of  the  nerve  centers,  or 
profound  anaemia  and  the  nervous  organization  is  de- 
pressed to  a  painful  degree. 

Then  the  thought  of  spirits  and  its  narcotic  action 
comes  like  an  obsession  which  is  irresistible.  The  mystery 
of  the  periodic  forms  of  these  states  occuring  at  regular 
intervals  has  not  been  explained  satisfactorily.  It  would 
seem  very  much  like  the  gathering  of  toxins  in  the  brain 
centers,  and  their  explosion  calling  for  relief. 

Alcohol  used  up  to  the  point  of  stupor  is  followed  by  a 
complete  subsidence  of  all  the  symptoms,  as  well  as  the 
desire  for  drink.  Then  recovery  follows.  Later  the  same 
symptoms  recur,  with  the  same  ending,  and  the  free  in- 
terval is  marked  by  the  rigid  abstinence  and  disgust  for 
spirits  and  its  effects. 

There  must  be  some  condition  of  exhaustion  and  de- 
rangement for  which  spirits  act  as  a  most  grateful  relief. 
This  relief  is  only  complete  when  profound  narcotism 
follows. 


PERIODIC  INEBRIETY  AND  ITS  SYMPTOMOLOGY.       73 

The  very  common  theories  that  alcohol  is  a  stimulant, 
bringing  new  force  and  power,  are  very  influential  in 
suggesting  and  promoting  its  use  at  these  periods,  and 
the  anaesthesia  and  narcotism  which  follows  confirm  the 
theory.  Thus  the  senses  and  power  of  reasoning  are 
deceived  by  its  effects,  interpreting  the  anaesthesia  as 
stimulation  and  new  force.  The  more  spirits  used,  the 
more  obscure  the  actual  condition  and  the  consciousness 
of  the  effects  become. 

The  word  "habit,"  describing  certain  acts  and  conduct 
which  seem  to  be  under  the  control  of  the  will  to  do  or 
not  to  do,  fails  to  indicate  the  conditions  of  the  periodic 
drinker. 

While  there  are  certain  acts  of  automatism  and  distinct 
rhythmic  uniform  movements  of  the  functional  activities 
of  the  body,  it  is  not  certain  that  they  are  under  control 
of  the  will,  and  can  be  regulated  by  reason  or  judgment. 
The  periodicity  of  the  drink  attacks  of  the  inebriate,  par- 
ticularly when  they  occur  at  exact  intervals,  open  up  a 
new  field  of  explanations  and  theories  that  are  not  clear 
or  satisfactory. 

It  is  very  evident  that  much  of  this  phenomena  is  be- 
yond the  control  of  the  will.  Whether  this  is  the  result 
of  conditions  which  could  have  been  controlled  is  un- 
certain. 

There  appears  to  be  two  classes  of  periodic  drinkers. 
One  in  which  the  drink  period  and  the  free  interval  are 
irregular,  uncertain  and  changeable.  In  the  other,  the 
drink  attack  is  always  the  same,  and  the  free  interval  is 
distinct  in  length  of  time  as  well  as  the  period  of  drinking. 

The  former  are  by  far  the  most  numerous  and  prom- 
inent. The  drink  attacks  in  these  cases  are  irregular,  the 
length  of  the  attack  differing  and  the  free  interval 
variable,  sometimes  lasting  years,  but  recurring  again  in 
about  the  same  way  and  under  the  same  conditions. 


74  INEBRIETY. 

The  free  intervals  continually  become  shorter  as  the 
disease  progresses,  and  often  this  form  of  drinking  dis- 
appears and  the  patient  becomes  a  regular  drinker. 

There  is  a  sub-class  of  this  form  of  drinking  that 
may  be  termed  accidental,  contagious,  environmental 
drinkers.  These  terms  refer  particularly  to  causes.  Thus 
one  will  only  drink  accidentally  on  meeting  certain  boon 
companions.  The  contagion  of  good  company  brings  on 
the  attack,  and  its  duration  depends  on  the  same  surround- 
ings. 

Others  drink  in  certain  particular  surroundings,  and  on 
certain  occasions,  and  are  temperate  in  all  other  condi- 
tions. They  are  periodic  drinkers,  but  their  drinking  and 
periodicity  is  uncertain,  subject  to  conditions  that  are 
unknown,  and  may  vary  widely  in  different  surroundings. 

Often  the  length  of  these  attacks  seem  to  be  controlled 
by  the  effects  of  the  spirits  on  the  organism.  Thus  in 
one  instance  a  few  hours  of  toxic  poisoning  from  spirits 
is  followed  by  reversion.  In  others,  many  days  of  ex- 
cessive drinking  occurs  before  the  paroxysm  dies  out. 

Great  varieties  of  brain  instability,  physical  and 
psychical  exhaustion  occur  both  preceding  and  following. 
This  is  manifest  in  the  diseased,  emotional,  unreasoning, 
fitful  activities,  with  changing  ambitions  and  ideals  of 
life,  showing  much  confusion  of  the  reason  and  loss  of 
control. 

Such  persons  begin  the  use  of  spirits,  with  or  without 
any  particular  temptation,  and  not  unfrequcntly  in  con- 
ditions and  surroundings  that  are  adverse  and  repulsive 
to  all  use  of  spirits.  There  are  in  many  communities  per- 
sons who  have  used  spirits  to  stupor  and  become  so 
thoroughly  disgusted  with  the  effects,  both  physical  and 
mental,  that  they  seldom  if  ever  drink  again. 

Some  physical  antagonism  to  the  effects  of  spirits  has 
been  roused  in  the  organism,  and  the  thought  of  it  is 


PERIODIC    INEBRIETY   AND    ITS    SYMPTOMOLOGY.     75 

painful.  Such  persons  are  emphatic  in  their  explanations 
of  the  ability  of  everyone  to  stop  the  use  of  spirits  at 
will,  and  often  this  emphasis  is  so  pronounced  as  to  be 
unreasonable,  and  suggest  a  weakness  that  is  manifest  in 
many  ways. 

Often  persons  who  are  so  very  emphatic  in  the  con- 
demnation of  the  weakness  of  drinking,  suggest  a  per- 
sonal experience  and  realization  of  the  effects  of  spirits. 
Frequently  they  are  secret  drinkers  themselves,  who  use 
spirits  at  irregular  intervals,  recover  and  show  an  in- 
temperate zeal  in  condemning  others  who  use  spirits. 
The  physical  and  psychical  repulsion  for  spirits  from  a 
toxic  state  may  last  a  lifetime,  growing  with  the  years, 
or  may  die  out  any  time  and  be  forgotten. 

It  is  always  a  question  of  great  clinical  importance  to 
find  out  the  first  impressions  on  the  mind  of  the  patient 
from  the  action  of  spirits.  If  this  has  been  very  pleas- 
ing, satisfactory  and  impressive,  it  will  always  be  more 
or  less  permanent,  no  matter  what  the  distress  and  dis- 
gust may  be  which  follows  the  subsidence  of  the  drink 
craze.  If  the  first  impressions  have  been  pleasing,  there 
are  reasons  for  believing  that  spirits  will  be  taken  again 
in  later  life,  but  if  they  have  been  painful  and  distressing, 
that  is,  after  the  first  excitement,  both  body  and  mind 
have  been  depressed  with  pain  and  uncomfortable  feelings, 
immunity  may  be  expected  in  the  future. 

This  is  only  a  general  rule,  to  which  there  are  many 
exceptions.  Thus  persons  who  have  been  disgusted  with 
the  flavor  and  odor  of  spirits,  or  persons  in  whom  the 
effects  of  spirits  have  been  depressing  have  been  able  to 
overcome  this.  Later  these  effects  change,  and  new  physi- 
cal conditions  call  for  the  renewal  of  spirits,  regardless 
of  its  distaste  or  pleasure. 

There  are  certain  persons  who  on  occasions  of  great 
emotional  excitement  and  depression  use  spirits  and  be- 


76  INEBRIETY. 

come  quickly  intoxicated  from  a  very  small  quantity. 
In  such  instances  there  is  no  particular  desire  for  spirits 
that  precedes  the  act.  It  comes  on  suddenly  and  without 
reason.  In  the  treatment  of  these  cases,  the  early  im- 
pressions suggest  how  far  possible  treatment  by  mental 
measures  can  be  depended  upon  to  build  up  resistance  to 
its  farther  use. 

There  are  always  wide  differences  in  the  physiological 
action  of  alcohol  on  the  organism.  These  are  to  be  con- 
sidered in  an  early  study.  Where  remedies  are  given 
for  the  purpose  of  producing  revulsion  and  distaste,  or 
dread  of  the  effects  of  alcohol,  the  results  have  not  been 
satisfactory  and  can  not  be,  unless  the  previous  history 
of  the  patient  is  known. 

If  the  organism  has  repelled  the  effects  of  alcohol  with 
suffering  and  pain,  a  mental  impression  may  be  produced 
that  will  increase  this  repellant  power,  and  the  recogni- 
tion of  this  fact  is  a  very  practical  aid  in  the  treatment. 

In  one  instance,  a  business  man  who  had  drunk  in  early 
life  and  been  profoundly  disgusted,  then  abstained  for 
many  years,  was  advised  by  the  physician  to  use  spirits 
for  debility.  Very  soon  he  was  profoundly  intoxicated, 
and  the  exhaustion  and  mental  disgust  which  followed  were 
very  intense.  From  that  time  on,  the  odor  of  spirits 
produced  nausea,  and  if  he  was  in  a  company  of  persons 
who  were  drinking,  this  produced  vomiting.  The  early 
impressions  became  a  dominant  antagonism  to  spirits. 

Often  persons  find  the  effect  of  spirits  pleasant  at 
first,  and  while  the  odor  may  not  be  very  agreeable,  the 
sedative  effect  is  pleasing.  In  this  there  is  a  constitu- 
tional predisposition  and  a  bias  to  use  it  for  its  imme- 
diate effects.  Many  of  these  persons  become  periodic 
drinkers,  and  have  distinct  periods  of  intense  fascination 
and  pleasure  for  the  effects  of  spirits,  and  then  periods 
of  repugnance. 


PERIODIC    INEBRIETY   AND   ITS    SYMPTOMOLOGY.     77 

In  this  way  a  medical  prescription  containing  spirits 
may  awaken  some  latent  tendency,  which  quickly  develops 
into  inebriety.  Common  examples  are  noted  of  men  who 
during  their  college  career  have  been  intoxicated,  and  at 
the  time  seem  to  enjoy  the  effects  of  spirits.  They  either 
become  abstainers  or  moderate  drinkers.  If  of  the  first 
class,  they  are  likely  under  conditions  of  great  strain  and 
mental  excitement  to  drink  to  great  excess  and  become 
intoxicated,  and  soon  become  periodic  drinkers. 

If  of  the  latter  class,  they  may  continue  to  drink  in 
great  moderation  and  become  literally  alcoholics.  Such 
men  often  reason  that  it  is  a  safe  use  of  spirits  to  take 
it  in  small  quantities  at  regular  intervals.  In  reality 
these  persons  frequently  drink  to  great  excess,  and  do 
not  seem  to  realize  that  the  moderate  drinking  has  any- 
thing to  do  with  it. 

There  is  one  class  of  moderate  drinkers  in  which  the 
free  interval  is  very  uniform  and  exact  as  to  time.  The 
following  are  examples. 

A  lawyer  with  a  neurotic  history,  who  began  to  drink 
in  college  at  intervals,  has  now,  after  a  period  of  thirty 
years,  distinct  drink  attacks  every  ninety-one  days,  and 
three  or  four  hours.  These  come  on  very  suddenly,  irre- 
spective of  surroundings  and  conditions,  and  last  from 
four  to  five  days. 

They  are  followed  by  acute  gastritis,  mental  and 
physical  exhaustion  and  recovery.  No  efforts  on  his  part 
have  succeeded  in  breaking  up  the  attacks  or  preventing 
their  return. 

On  two  occasions  he  was  locked  up,  and  became  acutely 
maniacal.  This  mania  was  only  quelled  by  the  use  of 
spirits.  He  now  goes  to  a  sanitorium  or  hospital  on  the 
approach  of  the  drink  storm.  He  is  given  small  quanti- 
ties of  spirits  and  watched  carefully,  and  is  thus  able  to 
recover  in  a  shorter  time,  with  less  debility. 


78  INEBRIETY. 

He  is  perfectly  temperate  during  the  interval,  and 
suffers  from  intense  disgust  from  the  smell  of  spirits  or 
the  sight  of  drinking  men.  A  number  of  cases  have 
been  noted  where  the  free  interval  was  marvelously  exact 
as  to  time,  and  no  prophylactic  treatment  could  check  it. 

A  second  case  was  that  of  a  business  man  who  never 
drinks  except  on  Thanksgiving  Day.  He  is  a  neurotic 
and  used  spirits  in  early  life  occasionally,  but  for  many 
years  he  has  been  abstinent  except  on  these  particular 
days.  He  will  attend  church,  dine  with  his  family,  seem 
to  be  perfectly  well,  then  suddenly  the  desire  for  drink 
will  come  over  him  so  impetuously  that  he  will  go  to 
his  room  and  drink  to  intoxication  for  twenty-four  hours 
or  more,  and  then  recover. 

A  third  case  is  that  of  a  physician  with  an  insane 
ancestry,  who  for  the  last  five  years  has  drunk  on  the 
Fourth  of  July,  and  at  no  other  time.  He  suggests  that 
the  noise  and  excitement  provoke  a  desire  for  drinking, 
and  that  this  desire  does  not  occur  at  any  other  time. 

A  brother  of  his  has  for  years  drunk  to  great  excess 
every  second  year — on  the  anniversary  of  his  marriage. 
The  time  between  the  drink  storms  he  is  perfectly  tem- 
perate, and  even  on  off  years  he  says  he  thinks  of  drink- 
ing on  the  return  of  the  period,  but  is  able  to  control 
himself. 

The  next  year  the  period  for  drink  arrives,  and  with 
it  an  intense  desire  which  he  is  unable  to  overcome.  A 
number  of  cases  have  been  noted  of  occasional  drinking 
men,  who  at  certain  definite  periods  drink  to  great  excess. 
At  all  other  times  they  seem  to  have  full  control. 

There  is  in  these  examples  both  a  psychical  and  physi- 
cal abnormality,  which  gathers  and  breaks  like  a  storm 
in  the  clear  sky.  In  all  probability  the  eccentric  acts 
and  strange  conduct  of  prominent  men  arc  due  to  con- 
cealed periodic  inebriety. 


PERIODIC    INEBRIETY   AND   ITS    SYMPTOMOLOGY.     79 

Many  business  men  suddenly  disappear,  going  to  some 
secretive  place  with  very  unsatisfactory  explanations  and 
frequently  without  any  ostensible  reasons,  and  return 
pale  and  feeble  after  a  week  or  more,  and  calling  in  the 
physician,  are  treated  for  malaria  or  some  other  condition 
of  nerve  exhaustion.  The  real  cause,  periodic  drinking, 
is  unrecognized. 

Some  of  these  persons  seem  to  be  aware  of  the  ap- 
proach of  the  attack,  and  make  extraordinary  efforts  to 
conceal  it  and  prevent  all  inquiry  or  possible  anxiety  from 
their  efforts.  They  often  show  great  activity  in  business, 
providing  for  possible  emergencies  and  obligations.  In 
reality,  setting  their  house  in  order  before  they  go.  After 
an  uncertain  interval  they  return  and  explain  their  ab- 
sence with  unusual  statements.  This  resembles  a  reasoning 
mania,  and  is  only  noted  because  of  its  unusual  character. 

Another  class  of  periodic  drinkers  show  no  apprehen- 
sion or  anticipation  of  the  drink  impulse,  which  comes  on 
so  suddenly  as  to  overwhelm  them  at  once.  One  man  will 
disappear  suddenly,  and  will  return  in  two  or  three  days, 
and  be  unable  to  explain  where  he  was  or  what  he  did. 

An  instance  of  this  kind  was  that  of  a  banker  who 
after  an  interval  of  fifteen  months  will  suddenly  disappear. 
Apparently  he  will  disguise  himself,  take  a  drink,  walk 
out  of  town,  take  a  way  train,  go  to  some  obscure  hotel, 
stay  two  or  three  days,  and  be  constantly  stupid.  Then 
wake  up  and  return,  and  be  very  indignant  if  anybody 
inquires  concerning  his  acts  during  this  period. 

Another  man  will  stop  in  the  middle  of  his  work,  buy 
a  quart  of  whisky,  rush  off  to  the  woods  and  conceal 
himself  and  drink  to  continuous  stupor.  This  quantity 
of  spirits  generally  lasts  him  two  days  or  more.  Then 
he  will  return,  and,  when  pressed  for  an  explanation,  say 
that  it  was  his  crazy  spell. 


80  INEBRIETY. 

A  number  of  very  sensational  disappearances  of  prom- 
inent men,  who  later  are  found  in  distant  places,  are  ex- 
amples of  this  class.  Very  curious  explanations  are 
given,  but  the  real  facts  are  concealed.  Often  the  person 
is  known  as  a  temperate  man,  or  perhaps  a  total  abstainer. 
At  all  events,  above  all  suspicion  of  being  an  inebriate. 

An  event  of  this  kind  was  the  subject  of  considerable 
comment  a  few  years  ago,  and  it  appeared  that  this  par- 
ticular act  was  one  of  many  which  had  been  known  to 
only  a  small  circle  of  friends.  He  was  a  man  of  very 
startling  oratorical  capacities,  and  a  temperance  lecturer 
of  unusual  magnitude.  In  the  middle  of  one  of  his 
lectures  he  became  pale,  stammered,  asked  his  audience  to 
excuse  him,  and  in  the  excitement  of  the  occasion  dis- 
appeared so  completely  as  to  excite  the  most  startling  ap- 
prehension. In  reality,  he  disguised  himself  and  went  to 
an  obscure  farmhouse  in  the  country,  where  he  remained 
intoxicated  for  several  days.  He  then  recovered  and 
under  disguise  went  to  a  distant  town  and  appeared.  He 
was  a  periodic  inebriate  in  which  the  drink  periods  came 
on  suddenly  at  long  intervals. 

A  number  of  persons  have  been  noted  who  did  not  dare 
to  attend  certain  festive  occasions,  such  as  college  or 
other  reunions,  or  banquets  where  wine  is  served.  The 
obsession  to  drink  on  such  occasions  is  so  strong  that 
they  become  intoxicated. 

There  are  both  physical  and  psychical  conditions  pres- 
ent, which  are  roused  into  activity,  demanding  the  nar- 
cotism. 

The  late  Dr.  Parrish  described  instances  of  persons  who 
never  drank  except  on  moonlight  nights,  particularly  in 
the  fall  months.  At  all  other  times  in  the  year  there  was 
no  impulse,  but  rather  a  repugnance  to  the  use  of  spirits. 

Instances  have  been  mentioned  of  persons  who  never 
drink  except  after  midnight.  The  rest  of  the  time  they 


PERIODIC    INEBRIETY   AND   ITS    SYMPTOMOLOGY.     81 

have  no  desire.  Another  class  use  spirits  in  the  early 
morning.  If  they  remain  sober  during  these  periods  there 
is  no  danger  of  the  return  of  the  drink  paroxysm  until 
the  same  time  the  next  day. 

The  periodic  drinker  is  always  a  neurotic  and  psycho- 
asthenic,  and  these  peculiarities  of  time  and  place  which 
recur  with  such  startling  uniformity  are  due  to  brain 
conditions  unknown. 

Explanations  given  by  themselves  or  their  friends  are 
so  obviously  unreal  as  to  be  unworthy  of  notice.  Nearly 
all  these  persons  are  secretive  in  their  drinking,  and  show 
great  adroitness  in  explaining  their  conduct  as  due  to 
other  causes. 

There  is  not  unfrequently  traceable  a  certain  ebb  and 
flow  in  the  nerve  energy  of  certain  persons,  noted  by 
exaltation  or  depression,  and  registered  by  obsessions  for 
spirits.  It  should  be  remembered  that  these  drink  cycles 
and  periodic  obsessions  may  change  into  other  abnormali- 
ties. Such  persons  may  frequently  become  drug-takers, 
or  show  marked  disturbance  of  the  brain  and  nervous 
system. 

Emotional  changes  are  characteristic.  Thus  intense 
excitement  over  trivial  things  or  depression  without  any 
sufficient  cause,  may  frequently  culminate  in  the  stupor  of 
intoxication,  and  after  this  is  over  melancholia  may  come 
on,  and  perhaps  suicidal  impulses.  A  man  may  at  inter- 
vals of  a  year  or  more  become  profoundly  depressed  and 
drink  to  great  intoxication  unless  controlled.  Then  the 
depression  passes  off  and  with  it  all  desire  for  spirits  and 
another  year  intervenes. 

In  a  certain  number  of  instances  these  drink  storms 
break  up,  and  their  recurrence  is  marked  by  other  symp- 
toms of  mental  perversions.  Sometimes  suicide  follows,  or 
wild  periods  of  speculative  mania  or  extreme  suspicion  of 
his  associates,  and  doubt  of  the  integrity  of  those  about 


82  INEBRIETY. 

him.  Several  cases  have  been  noted  where  a  man  pre- 
viously a  periodic  drinker,  suddenly  develops  startling 
symptoms  of  collapse,  and  concealed  manias,  which  puzzle 
the  physician,  and  are  often  the  subject  of  anxious  con- 
sultations. The  patient  recovers  in  a  few  weeks,  and  no 
one  traces  any  connection  between  these  obscure  physical 
states  and  his  previous  drinking.  In  all  probability  it  is 
only  another  phase  of  periodic  drinking. 

A  noted  officer  in  the  Civil  War  drank  to  intoxication 
with  the  yearly  reunion  of  his  comrades,  and  at  all  other 
times  he  was  temperate.  He  moved  away  where  it  was 
impossible  to  meet  his  old  comrades  as  before,  and  for 
many  years  afterwards,  during  the  month  of  September, 
he  suffered  from  obscure  neurosis  and  psychosis  for  two 
or  three  weeks  at  a  time. 

These  disorders  took  on  various  phases  of  profound 
exhaustion,  symptoms  of  Bright's  disease,  malaria  poison- 
ing, paralysis  of  the  lower  extremities,  insomnia,  loss  of 
appetite  and  high  fever.  He  recovered  from  all  of  these, 
and  for  the  following  year  would  continue  in  good  health 
and  spirits,  a  perfect  abstainer  in  every  particular. 

A  patient  under  our  care  many  years  ago,  who  made  a 
good  recovery,  returns  regularly  once  a  year  in  the  month 
of  April,  complaining  of  mental  disturbance  and  depres- 
sion, sometimes  suffering  from  severe  dyspepsia,  always 
from  insomnia,  and  alarmed  at  his  condition.  The  symp- 
toms arc  very  startling,  but  pass  away  after  four  or  five 
days  of  rest  and  quietness. 

He  is  a  total  abstainer  and  in  a  half  conscious  way 
fears  that  his  debility  will  lead  up  to  the  drink  craze,  and 
hence  comes  for  assistance.  There  is  in  this  a  very  marked 
psychical  clement,  controlled  by  his  general  physical  de- 
rangement. 

The  periodicities  of  the  drink  craze  are  exceedingly 
complex,  and  take  on  very  strange  forms,  so  much  so  that 


PERIODIC    INEBRIETY   AND   ITS    SYMPTOMOLOGY.     83 

there  can  be  no  classification  or  grouping  that  will  apply 
to  any  large  number  of  persons.  An  instance  of  a  very 
prominent  banker,  who,  after  a  very  serious  failure,  drank 
to  excess  and  was  placed  in  an  insane  asylum.  A  few 
months  later  he  recovered  and  resumed  business  again,  a 
thoroughly  temperate  man  in  all  his  thought  and  habits. 
Years  after  he  failed  again  and  drank  as  before,  recov- 
ered; and  the  third  time  he  failed,  drank  to  stupor  and 
died.  In  this  there  was  a  curious  return  of  the  drink 
impulse  under  similar  circumstances.  Several  cases  have 
been  noted  of  periodic  drinkers,  whose  drink  periods 
were  well  defined,  contracting  consumption  on  the  return 
of  the  drink  craze. 

Two  cases  of  this  class  drank  every  six  months  for 
many  years,  on  or  about  the  1st  of  July.  Both  of  them 
were  taken  with  acute  tuberculosis  at  the  time  the  drink 
craze  should  have  appeared.  One  went  to  the  North 
woods,  recovered,  and  the  following  year  the  same  symp- 
toms appeared  and  soon  after  he  died.  The  second  case 
went  under  the  care  of  a  quack  and  was  given  large  quan- 
tities of  whisky,  recovered,  in  part,  but  continued  drink- 
ing moderately  and  finally  died  of  the  disease. 

Pneumonia  is  a  very  common  acute  inflammatory  con- 
dition which  is  likely  to  occur  at  the  time  for  the  return 
of  the  drink  paroxysm. 

The  connection  between  the  return  of  the  drink  im- 
pulse and  acute  inflammation  of  the  lungs  is  seldom 
traced,  but  undoubtedly  it  is  very  close;  a  local  form  of 
paresis  starts  up  in  the  terminals  of  the  pneumogastric 
nerves,  and  this  is  not  uncommon  in  other  inebriates,  not 
necessarily  occurring  only  in  those  who  drink  periodically. 

Verv  interesting  studies  have  been  made  of  the  period- 
icity of  nerve  energy,  both  in  health  and  disease,  and  there 
is  evidently  a  very  wide  field  of  facts  that  are  now  prac- 
tically unknown.  It  may  be  assumed  that  the  periodic 


84  INEBRIETY. 

inebriate  has  developed  organic  changes  in  the  brain  cen- 
ters that  are  very  serious,  and  although  largely  unknown 
are  very  pronounced  in  their  symptomology. 

It  has  been  stated  by  good  authorities  that  only  verj 
highly  nervously  organized  persons  drink  at  intervals. 
The  coarser  and  more  demented  nervous  organizations 
demand  spirits  continuously.  This  has  some  basis  in  fact, 
but  has  not  yet  been  worked  out.  There  is  a  very  close 
connection  between  periodic  drinking  and  epilepsy. 

Frequently  the  drink  period  merges  into  a  muscular 
paroxysm  and  a  regular  epileptic  convulsion.  The  so- 
called  alcoholic  epilepsies  resemble  this,  although  there 
are  often  very  confusing  details.  While  the  use  of  al- 
cohol will  certainly  produce  epilepsy,  a  periodic  drinker 
who  has  distinct  intervals  is  evidently  on  the  road  to  this 
condition,  although  it  may  not  break  out  in  this  partic- 
ular form. 

All  such  cases  should  receive  the  very  closest  study, 
and  the  paroxysms  should  be  regarded  with  the  greatest 
interest. 


CHAPTER  IX. 
CONTINUOUS  DRINKERS. 

Synopsis. — The  regular  drinker  more  diseased  than  any  other 
class.  The  form  of  diseases.  Comparisons  with  total  abstainers. 
The  accumulative  action  of  alcohol.  Effects  slight  at  first.  Sat- 
uration from  spirits  dangerous.  Effects  on  the  psychic  centers 
show  derangement  of  mind.  Changes  of  conduct  and  appearance. 
The  senses  are  always  disturbed.  The  surface  of  the  body  de- 
ranged. Nutrition  is  seriously  effected.  Diseases  appear  ascribed 
to  different  causes.  Examples  of  injury  from  spirits.  Mortality 
greater  in  moderate  drinkers.  Stories  of  long  life,  fictions.  Beer 
drinkers  examples  of  degeneration.  Prognosis  bad.  Statistics 
confirm  this.  Delusions  in  common  life. 

The  man  who  uses  spirits  regularly  even  in  so-called 
moderation,  is  literally  paralyzed,  although  he  does  not 
realize  it.  This  paralysis  is  the  direct  result  of  con- 
tinuously taking  toxins  into  the  system  from  the  alcohol, 
and  consequent  cell  starvation. 

Very  interesting  studies  have  been  made  of  so-called 
moderate  drinkers,  who  claim  to  be  in  good  health,  and 
in  every  instance  defects  and  degenerations  have  been 
recognized  of  great  gravity. 

Dr.  C.  H.  Hughes  has  repeatedly  called  attention  to 
the  fact  that  the  moderate  or  continuous  drinker  of  spirits 
is  more  diseased  and  degenerate,  notwithstanding  his  ap- 
pearance of  health,  than  one  who  uses  spirits  at  intervals 
and  recovers. 

Dr.  L.  D.  Mason  has  made  many  studies  of  this  class, 
and  pointed  out  the  low  vitality  and  feeble  power  of  re- 
sistance and  extreme  susceptibility  to  disease,  noted  in 
such  persons.  The  increased  action  of  the  heart  is  always 
marked  by  high  tension,  and  with  this  comes  lack  of 
precision  and  muscular  control,  faults  of  memory,  slow- 
ness of  thought  and  inability  to  act  quickly. 

85 


86  INEBRIETY. 

There  are  evidently  two  classes  of  continuous  drinkers. 
One,  who  after  a  time  becomes  excessive  users  of  spirits, 
either  periodic  or  spasmodic,  at  irregular  intervals.  The 
other  class  develops  various  diseases  of  which  neuritis,  in- 
flammation of  the  kidneys  and  liver  are  most  common. 

They  are  not  called  inebriates,  and  yet  the  diseases 
from  which  they  suffer  are  traceable  to  the  use  of  spirits. 
Frequently  they  suffer  from  mental  troubles  that  are  ob- 
scure and  difficult  to  understand. 

Eminent  authorities,  in  all  departments  of  medicine, 
have  called  attention  to  the  pronounced  disease,  both  of  the 
brain  and  nervous  system,  in  persons  who  used  spirits 
regularly.  Recent  text-books  assert  very  positively  that 
in  certain  diseases  all  use  of  alcohol  must  be  discontinued 
in  the  treatment. 

The  cumulative  action  of  alcohol,  when  used  in  small 
doses,  is  unrecognized  and  yet  all  persons  who  are  mod- 
erate drinkers  have  a  great  variety  of  defects,  which 
they  ascribe  to  other  causes.  In  another  chapter  these 
effects  are  presented  in  some  detail.  The  effects  prob- 
ably begin  with  deranged  circulation,  increasing  and  di- 
minishing the  action  of  the  blood,  and  the  oxygen-carrying 
properties  of  the  red  blood  corpuscles. 

These  changes  are  slight  at  first,  but  later  the  use  of 
spirits  prevents  the  readjustment  of  the  disordered  con- 
ditions. The  minute  capillaries  fail  to  convey  the  blood 
uniformly  to  all  parts  of  the  brain.  The  nutrient  plasma 
is  diminished.  The  toxins  increase,  and  diminished  force 
and  vitality  follow. 

When  spirits  are  taken  to  excess,  a  point  of  saturation 
is  reached  in  which  spirits  are  exhaled  by  the  lungs,  and 
there  is  a  pronounced  form  of  circulatory  derangement. 
There  must  of  necessity  be  very  serious  disturbances 
when  the  alcoholic  ethers  accumulate  to  such  an  extent 
as  to  be  exhaled  through  the  lungs. 


CONTINUOUS  DRINKERS.  87 

When  the  first  effects  of  spirits  pass  away,  there  is  a 
sense  of  suffering  and  consciousness  of  low  vitality  that 
calls  for  a  renewal  of  the  drug,  and  in  this  way  the  de- 
lusion of  strength  and  vigor  is  created.  Clinical  com- 
parisons and  studies  of  persons  who  use  spirits  daily  and 
those  in  the  same  condition  who  are  abstainers,  show  very 
striking  differences. 

In  the  moderate  drinker  there  is  exaltation  of  the  ego, 
unusual  confidence,  and  unreasoning  faith  in  his  strength 
and  ability.  This  may  not  be  very  prominent  at  first, 
but  grows  with  the  increased  use  of  spirits.  His  conduct 
and  work  become  more  automatic  and  mechanical,  and  less 
original ;  he  is  more  incapable  of  change  and  adaptation 
to  new  conditions. 

His  pride  of  appearance  and  integrity  changes.  Soon  he 
will  suffer  from  defective  eyesight  and  troubles  of  hearing 
and  catarrh,  will  begin  to  wear  glasses,  will  visit  the  nose 
and  throat  specialist,  and  be  disturbed  about  chills  and 
drafts.  Later  he  will  complain  of  digestive  disturbances, 
and  perhaps  change  the  form  of  spirits,  or  combine  it 
with  milk  or  some  other  substance,  increasing  the  amount 
and  shortening  the  periods  between  the  times  of  using  it. 

Then  he  will  show  anxiety  and  unusual  zeal  to  defend 
its  use  and  claim  its  tonic  and  medicinal  powers  as  seen 
in  his  own  experience  to  be  very  valuable.  This  reason- 
ing is  often  marked  by  inconsistency,  of  which  he  is 
oblivious. 

Very  soon  the  face  and  skin  show  congestion  and 
palsy,  literally  vasomotor  paralysis  of  the  capillaries 
seen  in  the  face,  and  associated  with  this  are  pains  along 
the  track  of  the  large  nerves,  called  rheumatic. 

Insomnia  comes  on  and  the  physician  diagnoses  neu- 
rasthenia, brain  exhaustion,  or  perhaps  night-sweats  and 
chills  suggest  malaria  and  catarrhal  and  bronchial  trou- 


88  INEBRIETY. 

bles  give  hints  of  incipient  tuberculosis,  and  the  patient 
is  sent  to  another  climate. 

Together  with  this  there  is  irritability,  emotional 
changes  and  other  prominent  symptoms.  The  moderate 
drinker  sooner  or  later  becomes  an  invalid,  and  patron  of 
physicians,  both  regular  and  irregular.  His  credulity  and 
skepticism  suggest  all  sorts  of  means  and  measures,  which 
invariably  fail  to  bring  relief. 

Then  comes  proprietary  medicines,  and  should  they 
happen  to  contain  opium,  the  improvement  of  the  symp- 
toms are  so  marked  that  he  becomes  an  enthusiast  in  the 
hope  of  recovery. 

In  all  this  search  for  health  there  is  no  thought  of  the 
moderate  use  of  spirits  as  a  primary  cause.  His  increas- 
ing weakness  and  complex  symptoms  suggest  different 
kinds  of  spirits  which  he  uses  with  great  eagerness  and 
confidence. 

One  fact  impresses  itself  on  the  mind  of  the  patient — 
that  he  is  unable  to  do  what  he  did  formerly,  and  that 
he  is  gradually  becoming  weaker.  His  low  vitality  and 
profound  exhaustion  after  mental  and  muscular  activity 
and  the  slow  power  of  repair  from  injuries  attract  the 
physician  who  ascribes  it  to  other  causes.  A  sudden  chill 
and  acute  pneumonia  end  fatally  in  a  few  days. 

The  diagnosis  of  Bright's  Disease  is  sometimes  made, 
and  the  advice  to  stop  the  use  of  spirits  is  followed  by 
depression  and  so-called  collapse  that  forces  him  to  resume 
its  use  again. 

After  a  time  the  constant  user  of  spirits,  even  in  great 
moderation,  will  show  some  disturbed  states  or  defects  and 
degenerations  of  some  particular  class  or  of  some  par- 
ticular organ  of  the  body.  Thus,  in  one  case  a  moderate 
drinker  exhibited  emotional  changes,  was  excitable,  suspi- 
cious and  angry  without  cause.  This  was  very  unusual 


CONTINUOUS  DRINKERS.  89 

in  his  conduct.  Another  man  was  indifferent,  stupid  and 
neglectful  of  common  every-day  duties.  His  former  cau- 
tion and  conservatism  changes  to  the  other  extreme  and 
he  becomes  a  speculator,  is  visionary  and  unwise  in  his 
thought  and  conduct. 

Probably  the  derangement  of  nutrition  recognized  in 
capricious  appetite  is  the  most  common  disturbance.  A 
great  variety  of  nutrient  disturbances  occur  that  resist  all 
treatment. 

In  practical,  every-day  life  where  exact,  uniform  work 
is  required,  the  moderate  drinker  becomes  more  and  more 
incapable.  Men  working  on  the  railroad  or  in  positions 
where  exactness  of  work  as  to  time  and  accuracy  are  re- 
quired are  very  soon  discharged  as  incompetent. 

This  inability  is  due  to  faulty  sense  perceptions  and 
feeble  reasoning  powers,  with  uncertain  memory  and  in- 
ability to  act  rapidly  and  with  clear  judgment.  Em- 
ployers of  coarse  muscular-labor  workmen  recognize  that 
the  daily  output  of  work  is  greatly  diminished  in  persons 
who  use  spirits  constantly. 

Thus  groups  of  Italians  who  use  spirits  daily  arc  un- 
certain, and  their  muscular  output  is  unreliable,  particu- 
larly in  emergencies.  Injuries  of  any  kind  also  are  more 
serious,  with  a  slower  convalescence  than  in  others  who  are 
abstainers. 

The  steady  beer-drinker  is  a  very  marked  example  of 
progressive  degeneration.  The  delusive  appearance  of 
health  noted  in  the  workmen  about  breweries,  and  par- 
ticularly on  the  docks  at  Liverpool  is  contradicted  by  the 
high  mortality  and  frequent  fatal  results  from  insig- 
nificant injuries. 

A  large  percentage  of  beer  drinkers  die  before  middle 
life,  or  are  invalids  and  taken  to  hospitals  to  pass  the 
remaining  years. 


90  INEBRIETY. 

It  is  a  curious  illustration  of  popular  ignorance  that 
the  moderate  use  of  spirits  and  beer  is  thought  to  favor 
ideal  health  and  longevity,  and  that  if  the  user  could  con- 
tinue its  moderate  use  the  best  results  would  follow. 

Repeated  stories  in  the  daily  press  of  persons  who  use 
spirits  in  small  quantities  regularly  for  long  periods  of 
time,  and  not  only  do  not  suffer,  but  are  better  for  it, 
are  often  found  to  be  mere  myths ;  for  while  it  is  pos- 
sible for  some  persons  living  in  quiet  surroundings,  with 
little  or  no  mental  strain  or  activity,  to  use  small  doses 
of  spirits  regularly  for  a  period  of  years,  experience 
shows  that  they  are  the  exceptions  to  the  rule.  Careful 
studies  of  moderate  drinkers  show  that  they  always  de- 
velop some  chronic  disease,  and  become  broken  down  in  a 
very  few  years. 

Dr.  Mason,  in  a  recent  study,  showed  that  both  beer 
and  spirits  taken  in  moderation  always  develop  diseases, 
and  are  followed  by  a  shortened  life  and  complex  degen- 
erations from  which  there  are  few  if  any  exceptions. 

Many  studies  have  been  made  of  persons  of  this  class, 
with  a  view  of  determining  their  freedom  from  disease  and 
their  average  mortality,  but  the  results  have  always  been  a 
confirmation  of  the  statement  that  all  persons  who  drink 
in  moderation  suffer  more  or  less  from  degenerations, 
either  acute  or  chronic. 

In  business  circles  the  moderate  drinker  is  regarded  with 
suspicion,  particularly  as  to  his  capacity,  reliability  and 
stability.  Pie  may  be  tolerated,  but  he  is  regarded  as  a 
doubtful  factor  in  the  hard,  grinding  struggle  of  trade. 

In  the  social  and  scientific  world  many  men  are  known 
as  moderate  drinkers,  and  there  is  very  little  question 
about  their  mental  impairment,  and  yet  after  a  time  a 
strange,  unusual  will  is  revealed  at  death.  Their  affairs 
become  involved  in  strange  financial  difficulties.  Their 


CONTINUOUS  DRINKERS.  91 

credulity  and  unusual  conduct  are  marked  in  some  start- 
ling way. 

An  example  was  that  of  a  noted  statesman  who  sud- 
denly exhibited  a  most  extraordinary  course  of  conduct, 
and  a  short  time  after  he  suddenly  died.  The  fact  of 
his  moderate  drinking  explained  this  sudden  lapse  of 
good  judgment. 

Many  instances  are  prominent  where  all  unexpectedly 
changes  of  religion,  occupation,  conduct,  judgment,  cau- 
tion and  all  other  conditions  which  have  marked  the  pre- 
vious career  occur,  and  are  traceable  to  the  cumulative 
degenerative  action  of  alcohol,  which  has  been  used  for 
years  in  so-called  moderation. 

It  may  be  stated  as  a  fact,  the  exceptions  to  which 
only  prove  the  rule,  that  the  moderate  and  steady  user 
of  spirits  is  always  diseased  and  degenerate,  whether  we 
recognize  it  or  not.  He  may  do  his  accustomed  work, 
but  it  will  be  automatic.  His  mental  and  muscular  vi- 
tality is  impaired.  His  resistance  to  disease  is  diminished 
and  his  susceptibility  increased. 

He  is  not  only  aged,  but  his  vitality  is  reduced  to  the 
point  where  restoration  is  more  and  more  uncertain.  The 
drink  craze  may  die  out,  and  he  may  be  a  total  abstainer, 
but  how  far  he  can  recover  is  an  open  problem.  It  has 
been  stated  elsewhere  that  moderate  drinking  in  this 
country  is  far  more  serious  than  in  Europe.  This  fact  is 
founded  on  statistics.  Recent  studies  of  the  beer  drinker 
and  the  user  of  wines  and  spirits  in  Europe  show  the  same 
conditions,  only  less  marked. 

Thus  in  Munich,  the  home  of  the  supposed  finest  qual- 
ity of  beer,  heart  and  kidney  diseases  prevail  to  an  alarm- 
ing extent,  and  circulatory  diseases  constitute  one  of  the 
largest  factors  in  mortality,  and  these,  more  and  more, 
are  traced  to  the  toxaemias  due  to  alcohol. 


92  INEBRIETY. 

It  is  a  curious  fact  not  recognized  that  the  constant 
drinker  suffers  from  delusions  concerning  himself.  Where 
he  is  an  active  brain  worker  it  is  absolutely  certain  that 
he  can  not  continue  the  use  of  spirits  any  great  length 
of  time  without  marked  impairment,  and  yet  he  never 
realizes  this,  but  is  constantly  deceiving  himself  with  the 
faith  that  he  is  able  to  do  as  much  as  ever  and  with  the 
same  skill  and  vigor. 

The  muscular  worker  has  the  same  faith  and  confi- 
dence in  his  ability,  but  actual  measurements  of  his  out- 
put prove  the  delusion  that  he  is  laboring  under.  The 
evidence  of  the  impairment  of  the  moderate  drinker  is 
accessible,  can  be  studied  in  every  community. 

In  institutions  the  effort  to  restore  such  persons  is  at- 
tended with  great  difficulty  and  prolonged  invalidism. 


CHAPTER  X. 

INEBRIETY  A  FORM  OF  MORAL  INSANITY. 

Synopsis. —  What  moral  insanity  represents.  An  accurate  scien- 
tific term  very  common  in  inebriates.  Marked  following  inebriate 
ancestors.  Indicating'  arrested  development.  Can  be  acquired. 
Examples  frequently  noted.  Symptoms  common  to  chronic  in- 
ebriates seen  in  persons  at  the  beginning  of  inebriety.  Alcohol  de- 
stroys the  moral  sense  first,  in  some  persons  very  prominently. 
Examples  given  seen  in  both  extremes.  In  the  supposed  Intel- 
lectual and  wealthy  classes  and  in  the  lowest  and  most  defective. 
Should  be  recognized  in  the  study  and  treatment.  A  particular 
form  of  degeneration  going  through  successive  stages.  A  form 
of  insanity  not  recognized  in  the  books.  One  that  is  more  or  less 
common  in  certain  circles  of  society.  When  convicted  of 
crime  cannot  be  defended  by  any  known  symptoms  of  insanity, 
hence  are  punished  as  responsible.  A  new  field  for  psychical  study 
that  will  occupy  a  very  large  place  in  the  future. 

The  term  moral  insanity  represents  a  condition  of  the 
brain  in  which  all  sense  of  right  and  wrong,  duty  and 
obligation  is  feeble  or  wanting.  Recent  exhaustive  stud- 
ies of  the  brain  and  mental  phenomena  indicate  a  loss 
of  the  ethical  sense,  and  the  consciousness  of  the  right 
relations  to  others,  in  many  persons  who  otherwise  seem 
to  be  normal,  but  whose  truthfulness,  honesty  and  respect 
for  law  and  the  feelings  of  others  seem  to  be  entirely 
wanting. 

The  term  moral  insanity  has  been  used  to  describe  this 
condition,  and  in  a  general  way  it  may  be  considered 
fairly  accurate,  because  it  describes  a  condition  which 
exists,  although  but  little  known.  It  should  be  studied 
more,  for  no  real  reform  in  public  or  private  life  is  pos- 
sible until  the  causes  are  removed. 

In  inebriety  these  symptoms  of  moral  defect  are  com- 
mon, no  matter  what  the  conditions  and  standing  of  the 
persons  may  be.  It  seems  to  follow  the  poisoning  from 

alcohol,   and  in   some   cases  very  markedly.      Two  classes 

93 


94  INEBRIETY. 

appear  prominently — one  hereditary,  and  the  other  ac- 
quired. Wherever  there  is  a  marked  history  of  heredity, 
of  alcoholic  parents,  or  of  neurotic  degenerate  ancestors, 
a  feeble  or  deficient  consciousness  of  right  and  wrong  is 
found. 

Alcohol  used  continuously  retards  growth,  diminishes 
vitality  and  prevents  development.  Drinking  parents 
have  deficient  vitality  and  are  unable  to  transmit  to  the 
next  generation  full  normal  vigor.  The  last  and  highest 
formed  element  of  brain  power  is  the  first  to  suffer  from 
alcohol. 

Hence  drinking  parents  seldom'  have  children  with  nor- 
mal consciousness,  sensibility  and  ethical  growth.  This 
faculty  will  be  wanting  or  very  feeble  in  development. 
This  is  the  rule  to  which  the  exceptions  are  rare.  The 
defect  may  be  associated  with  much  intelligence,  intel- 
lectual capacity  and  power  to  conceal  this  condition. 

A  man  prominent  in  the  political  world  acts  in  private 
life  as  if  devoid  of  all  sense  of  justice,  of  right  and 
wrong,  and  duty  to  others.  He  is  untruthful  and  dis- 
honest, and  when  his  own  interests  are  concerned  will 
sacrifice  any  person  or  principle  to  gain  his  ends.  His 
parents  were  wine  dealers  and  drinkers,  both  of  them 
waiting  on  customers  over  the  bar. 

Only  one  child  grew  to  manhood  who  entered  politics 
as  a  trade.  He  is  temperate,  but  a  moral  paralytic,  or  a 
moral  maniac,  with  capacity  to  conceal  his  condition. 

A  man  who  became  one  of  the  greatest  swindlers  and 
forgers  of  his  day,  was  able  to  keep  out  of  prison  by 
intrigue  and  cunning,  came  from  drinking  parents.  To 
his  associates  he  is  known  as  being  without  any  sense  of 
duty  and  obligation  to  any  one,  and  is  a  literal  brigand. 

That  these  conditions  are  due  to  inheritance  is  ap- 
parent from  the  following: 


INEBRIETY  A  FORM   OF  MORAL  INSANITY.         95 

A  boy  with  parents  who  drank  excessively  was  taken  in 
infancy  and  educated  in  a  most  careful  way;  all  the 
higher  faculties  were  cultivated  to  an  unusual  degree, 
and  he  entered  the  church  as  a  brilliant  clergyman.  He 
was  found  to  be  untruthful  in  regard  to  himself,  suspi- 
cious of  others  and  grasping,  even  up  to  the  border  of 
theft  in  many  matters.  The  collections  in  church  had  to 
be  kept  out  of  sight,  and  always  suffered  if  they  passed 
through  his  hands. 

He  became  involved  in  spreading  scandal,  and  seemed 
oblivious  of  the  danger  of  such  conduct,  and  broke  up 
one  church  by  his  irregularities.  For  ten  years,  until  his 
death,  he  was  in  continual  trouble  with  every  church  he 
was  associated  with.  Here  the  evidence  was  clear  that  he 
had  inherited  defective  conscientiousness,  which  defect  no 
training  or  surroundings  could  overcome. 

In  cases  where  inebriety  has  been  acquired  by  acci- 
dent, such  as  contagion  of  surroundings  and  conditions 
of  living,  these  moral  insanities  vary  widely  and  are  not 
so  general. 

In  one  instance  excessive  untruthfulness  and  dishonesty 
in  all  business  relations  was  associated  with  sympathetic 
tenderness  to  associates.  In  another,  intense  suspicion 
and  doubt  of  the  honesty  of  others  was  associated  with  an 
extreme  desire  to  be  truthful  personally. 

Another  individual  was  intriguing,  secretive,  treach- 
erous, and  uncertain  in  his  talk,  and  yet  lived  otherwise  a 
moral,  upright  life. 

These  are  examples  of  a  class  almost  infinite  in 
variety  and  manifestation,  and  all  show  profound  changes 
in  the  moral  faculties.  The  more  common  forms  are 
illustrated  in  this  case :  A.  B.,  a  business  man  of  good 
reputation  and  standing  in  the  community,  began  to 
drink  after  a  protracted  illness  from  typhoid  fever.  Two 
years  later  he  became  an  inebriate.  His  mind  continued 


96  INEBRIETY. 

bright  and  clear,  but  his  character  changed.  He  was  de- 
ceitful, suspicious  and  slanderous,  and  thought  his  sons 
and  clerks  were  robbing  him,  and  that  his  wife  was  in 
league  with  them. 

He  had  his  books  examined  by  an  expert,  and  was  still 
in  doubt  when  they  were  found  correct.  He  told  false- 
hoods about  his  business  and  family,  and  grew  more  and 
more  egotistical  about  his  mental  capacity  to  grasp  and 
decide  all  matters.  He  was  harsh  and  tyrannical  to  his 
wife  at  times,  lost  all  pride  of  character  in  the  com- 
munity and  sense  of  obligation  to  others. 

He  was  exacting  in  everything  done  for  his  own 
interests,  and  oblivious  of  others'  feelings  and  tastes.  As 
a  patient  he  was  intensely  selfish  and  grasping,  even  to 
theft,  was  fawning  and  obsequious,  promising  everything 
and  doing  the  opposite. 

In  the  summary  of  the  common  symptoms  following  the 
use  of  alcohol,  untruth  fulness,  or  a  low  respect  for  their 
word,  is  most  prominent.  A  man  who  previously  took 
pride  in  the  correctness  of  his  promises  and  statements, 
will  become  indifferent  to  his  word,  whether  true  or  false. 

A  man  previously  honest  and  trustworthy  will  be  found 
doing  dishonest  things,  cheating  persons,  taking  advan- 
tage in  little  matters,  and  failing  to  act  fairly  in  the 
interests  of  himself  or  others.  Then  follows  suspicion  of 
motives  and  conduct,  doubting  the  honesty  and  purity 
of  persons. 

This  deepens  into  delusions  of  intrigue  and  deception 
of  others,  extreme  pessimism  and  doubt  of  everything ; 
or  a  state  of  mind  follows  in  which  the  distress  of  others 
is  pleasing. 

Recklessness  in  the  use  of  money,  throwing  it  away 
without  motive  or  purpose,  or  extreme  parsimony  to 
hoard  it,  and  grasping  selfishness,  equally  unreasonable, 
are  common.  As  in  other  insanities,  exaltation  of  the 


INEBRIETY  A  FORM  OF   MORAL  INSANITY.         97 

ego  follows,  and  intense  confidence  in  themselves,  their 
power  of  reasoning  and  their  ability  to  do  anything  pos- 
sible is  present. 

Many  persons  who  exhibit  all  these  symptoms  appear 
to  be  but  little  changed  in  other  respects.  They  carry 
on  business,  seemingly  make  good  plans  and  execute  them, 
and  appear  to  casual  observers  the  same. 

These  insanities  seem  to  concentrate  into  particular 
lines  or  ranges  of  thought.  In  one  case  an  inebriate 
lawyer  doubted  the  honesty  of  everyone  and  thought  no 
one  was  pure  or  had  good  motives,  and  yet  he  acted 
rationally  on  all  other  matters.  In  another  case  a  teacher, 
who  had  drank  many  years,  became  a  secret  thief,  pur- 
loining everything  which  he  fancied,  and  when  likely  to 
be  detected  restored  them  in  some  mysterious  way. 

He  appeared  honest  and  talked  honestly,  and  yet  when 
not  observed  took  every  opportunity  to  appropriate  any- 
thing that  came  in  his  way.  A  number  of  cases  of  in- 
ebriates have  been  reported  where  this  kleptomaniac  im- 
pulse took  on  certain  peculiar  forms.  Thus,  one  man 
while  drinking  stole  Bibles;  another  jewelry,  and  when 
discovered  gave  them  up  freely.  One  man  stole  wash- 
tubs.  A  woman  inebriate  always  took  aprons  and  towels ; 
another  man  stole  soap,  and  so  on. 

The  most  unusual  and  unreasonable  things  are  taken, 
concealed  and  given  up  freely  without  any  sense  of  the 
nature  of  the  acts.  One  class  of  inebriates  exhibits  this 
insanity  in  malicious  slander,  another  in  extreme  suspicion, 
others  in  vindictiveness  to  resent  real  or  imaginary  evils, 
others  in  immorality  and  impurity  of  act  and  thought. 
Many  of  the  chronic  cases  exhibit  all  these  phases  in  one. 

The  oft-repeated  statement  that  "inebriety  is  criminal- 
ity," is  true  in  a  general  sense,  when  criminality  is  under- 
stood as  a  course  of  conduct  in  which  duty,  right,  and 
obligations  to  others  are  ignored.  The  inebriate  has 


98  INEBRIETY. 

physically  defective  senses;  he  is  not  able  to  adjust  him- 
self to  the  outside  world  correctly,  because  his  knowledge 
of  its  relations  is  imperfect.  His  power  of  reasoning  is 
also  deranged,  because  the  impressions  from  without  are 
faulty  and  the  integrity  of  the  normal  action  of  the 
nervous  system  is  impaired. 

The  coarser  physical  lesions  in  the  inebriate  are  well 
recognized  and  can  be  traced  in  all  cases.  Beyond  these, 
conduct  indicates  the  higher  moral  defects  and  changes. 
Mental  changes,  as  loss  of  pride,  of  character,  of  honor, 
respect  for  the  truth,  of  duty  to  others,  low  motives  or 
no  motives,  extreme  pessimism,  are  the  first  and  common 
changes  wrought  by  alcohol  which  lead  up  to  criminal 
acts. 

The  paralyzing  action  of  alcohol  is  first  seen  on  the 
moral  brain  in  the  dullness  and  defective  workings  of  its 
higher  functional  activities.  The  change  observed  when  a 
man  is  under  the  influence  of  spirits  is  vaguely  called  the 
removal  of  the  restraint  of  reason  and  the  dominance  of 
the  animal  impulses — the  brute  triumphing  over  the  real 
man.  In  reality  it  is  palsy  of  the  consciousness,  a  cut- 
ting off  of  some  part  of  the  higher  brain,  and  conse- 
quent management  by  the  lower  brain  and  its  workings 
on  animal  levels. 

Impressions  are  vague,  the  meaning  confused  and  ob- 
scure ;  the  higher  relation  of  events  and  conditions  of 
life  are  unrecognized.  It  is  asserted  that  three  per  cent, 
of  all  persons  born  are  without  normal  consciousness  of 
right  and  wrong.  They  have  retarded  brain  development. 
The  part  of  the  brain  which  determines  moral  control,  or 
consciousness  of  the  higher  duties  is  wanting  or  unde- 
veloped. 

Such  persons  are  defectives,  and  insane  in  the  general 
meaning  of  that  word,  and  like  dements,  are  incapable 
of  normal,  healthy  adjustment  to  the  relations  of  life. 


INEBRIETY  A  FOEM  OF   MORAL  INSANITY.         99 

In  cases  where  an  apparently  normal  state  of  this 
brain  function  has  existed  and  then  a  great  abnormality 
follows  in  thought,  word  and  conduct,  disease  is  present. 
Comparisons  of  the  conduct  and  character  of  inebriates 
before  their  use  of  alcohol  and  after  they  become  regular 
drinkers,  bring  out  some  startling  facts  that  are  yet  un- 
recognized. 

From  the  lowest  type  of  the  demented  inebriate  at  the 
bottom,  to  the  moderate  drinker  and  fashionable  club- 
man at  the  crest,  there  is  a  distinct  relation  and  chain  of 
cause  and  effect.  The  clear  moral  insanity  of  the  one  is 
traceable  up  to  the  other  without  any  sharp  dividing  lines. 
The  moderate  drinker  and  clubman,  who  proves  to  be  a 
defaulter,  or  one  who  is  involved  in  conduct  that  is  crim- 
inal, or  who  becomes  a  principal  in  crime,  is  suffering 
from  disease  differing  only  in  degree,  but  not  in  kind 
from  the  degenerate  inebriate  tramp. 

Moral  insanity  is  a  very  prominent  phase  of  inebriety. 
Its  absence  in  any  given  case  is  an  exception  to  the  rule. 
A  man  with  a  high  moral  development,  usually  after  he 
becomes  an  inebriate,  may  return  to  the  form  and  externals 
of  his  previous  character.  He  may  be  more  emphatic  in 
his  display  of  some  qualities  such  as  religious  observance 
and  duty,  and  yet  in  business  or  social  matters  be  ob- 
livious of  all  obligation. 

One  such  man  who  prayed  for  inebriates  and  lectured 
on  temperance  carried  on  an  intrigue  and  sold  his  influence 
to  the  highest  bidder.  Another  man  acted  as  an  agent 
for  the  sale  of  stolen  goods,  and  at  the  same  time  carried 
on  a  great  reform  revival ;  and  another  was  engaged  in 
gold  mine  swindles,  while  lecturing  every  night  for  gospel 
temperance.  The  moral  insanity  was  called  hypocrisy, 
and,  in  legal  phrase,  was  malicious,  criminal  and  vicious. 

In  reality  it  was  degeneration  and  disease,  the  breaking 
down  of  one  part  of  the  brain  while  the  others  remained 


100  INEBRIETY. 

apparently  clear.  In  our  Civil  War  a  noted  general 
drank  to  excess  at  times.  Previously  he  was  noted  for  his 
hearty  frankness  and  honesty,  but  was  found  unreliable, 
intriguing  and  failed  when  needed  most.  He  showed 
petty  weakness  and  untruthfulness,  with  malice  that  was 
unknown  before  in  his  conduct.  He  finally  died  a  moral 
wreck,  after  the  war  was  over,  having  become  almost  crim- 
inal in  his  thoughts  and  acts. 

A  clergyman  became  a  secret  inebriate  and  later  became 
involved  in  a  low  intrigue  and  was  turned  out  of  the 
pulpit.  He  was  insane ;  his  consciousness  became  palsied, 
and  for  a  time  he  taught  ethical  truth  automatically. 
The  possibility  of  one  part  of  the  brain  being  affected 
and  the  rest  doing  normal  work,  and  this  condition  being 
concealed,  is  a  reality  which  experience  frequently  con- 
firms. 

The  inebriate  who  has  lost  pride  of  character  and 
sense  of  duty  and  obligation,  truthfulness  and  honor 
may  seem  to  be  the  same  in  many  ways  for  a  long  time, 
but  sooner  or  later  this  diseased  moral  condition  will 
spread,  and  his  whole  organism  show  degeneration.  The 
following  are  the  notes  of  some  cases  which  have  occu- 
pied public  attention  and  been  the  topic  of  much  bitter 
discussion. 

CASE  1.  John  Blank.  His  father  was  a  strolling 
actor  of  irregular  character  and  an  inebriate.  He  mar- 
ried a  woman  of  average  ability  from  a  good  family. 
The  father  died  before  John  was  born,  and  two  years 
later  his  mother  married  again.  John  was  brought  up 
with  great  care  and  tenderness.  His  later  education  was 
of  the  best  character.  He  was  the  leader  of  his  class  as  a 
scholar  and  an  athlete.  To  his  mother  and  intimates  he 
displayed  an  intense  selfishness,  putting  his  interests  and 
desires  above  those  of  all  others,  and  had  no  consideration 
for  pain  and  distress  that  he  caused  to  those  about  him. 


INEBRIETY  A  FORM  OF  MORAL  INSANITY.         101 

He  was  cruel  in  his  conduct  to  anyone  who  was  in  the 
way  of  his  achievement  of  any  purpose  or  desire.  He 
finally  became  a  lawyer,  and  was  thoroughly  unscrupulous 
in  money  matters,  although  not  miserly  or  avaricious. 
As  a  politician  he  was  without  honor  or  pride  of  char- 
acter and  would  stoop  to  anything  to  accomplish  his 
purpose. 

He  married  a  rich  woman  and  soon  after  swindled  his 
father-in-law,  and  possessed  himself  of  a  large  property. 
Then  he  drank  and  began  to  live  a  fast  life.  Had  a 
mistress  and  attended  horse  races.  Wherever  he  went  he 
swindled  and  falsified,  and  was  feared  by  everyone  who 
had  any  dealings  with  him.  He  went  into  stock  gambling 
and  was  swindled  and  swindled  others.  He  was  cruel  and 
violent  in  his  conduct  toward  his  wife  and  children.  After 
a  period  of  excessive  use  of  spirits  he  killed  his  wife  and 
made  no  effort  to  conceal  it  or  run  away. 

On  trial  his  schemes  for  deception  and  fraud  were  re- 
vealed to  the  astonishment  of  everyone.  Truthfulness, 
honor,  duty  and  all  the  qualities  which  go  to  make  char- 
acter were  absent.  He  was  convicted  of  murder,  but  the 
sentence  was  commuted  to  life  imprisonment. 

In  this  case  the  moral  idiocy  was  inherited.  The  higher 
part  of  the  brain  was  undeveloped  and  beyond  the  reach 
of  culture  and  education.  Without  education  he  would 
have  sunk  to  a  low  tramp  criminal  and  burglar,  and 
been  a  pauper  degenerate,  dying  early.  With  education 
he  became  a  high-grade  criminal,  because  he  was  unable 
to  appreciate  ethical  truth  or  moral  relations.  He  was 
insane  from  birth ;  alcohol  intensified  and  developed  this 
condition.  The  insanity  was  of  the  higher  ethical  brain, 
and  concealed,  except  to  those  who  knew  him  intimately. 

CASE  2.  The  second  case  came  from  a  good  family, 
and  was  normal  in  all  his  relations  to  others ;  was  truth- 
ful, honest  and  seemed  generous  and  very  kind.  After  a 


102  INEBRIETY. 

severe  attack  of  typhoid  fever,  during  which  he  was  given 
large  quantities  of  spirits,  he  began  to  use  alcohol  daily. 
His  father  died  and  left  him  in  charge  of  a  large  business 
interest.  His  character  changed.  His  regard  for  his 
work  was  lost.  He  was  suspicious  of  his  mother  and 
brothers,  and  took  money  out  of  the  business  and  con- 
cealed it.  He  left  his  home  for  a  hotel,  and  when  drink- 
ing excessively,  wrote  violent,  scandalous  letters  to  his 
family  and  employees.  He  associated  with  low  women, 
but  treated  them  harshly,  refused  to  give  them  money 
and  was  constantly  in  trouble.  No  public  exposure  dis- 
turbed him.  He  was  frequently  in  court  for  petty 
swindles,  and  refused  to  pay  unless  forced  to.  His  busi- 
ness declined  and  was  finally  taken  out  of  his  hands,  and 
he  became  a  low  blackmailer  and  beggar,  drinking  at  all 
times  and  places.  He  was  examined  for  lunacy  and 
decided  to  be  sane.  No  symptoms  of  insanity  were 
found;  nothing  but  wilfullness  and  vicious  cunning  was 
the  opinion  of  Philadelphia  experts.  Finally  he  was 
convicted  as  an  accessory  to  murder  and  incendiarism  and 
sent  to  prison  for  life.  This  was  clearly  moral  insanity, 
acquired  and  intensified  by  drink.  His  family  and  early 
history  showed  no  trace  of  defective  conscientiousness  or 
moral  weakness. 

His  parents  were  temperate,  moral  people,  church 
members,  above  all  suspicion.  In  his  early  life  he  at- 
tended church  and  Sunday-school,  and  had  a  lovable,  at- 
tractive character.  He  began  his  business  career  with 
his  father,  and  seemed  in  every  way  honest  and  honor- 
able. He  displayed  excellent  judgment,  and  was  en- 
trusted with  large  business  interests,  which  he  faithfully 
executed.  During  his  illness  with  the  typhoid  fever  his 
father  died,  and  on  his  recovery  he  was  put  in  charge  of  the 
business.  A  total  change  of  character  which  followed  his 
recovery  might  have  been  due  to  the  spirits  given,  or  to 


INEBRIETY  A  FOBM  OF  MOBAL  INSANITY.       103 

the  injury  to  some  brain  centers  from  the  fever.  At  all 
events,  the  use  of  alcohol  intensified  and  fixed  this  con- 
dition. In  both  of  these  cases  a  great  deal  of  mental 
vigor  and  apparent  sanity  was  associated  with  his  low 
morals  and  brain  force.  In  the  latter  the  experts  could 
find  no  impairment  of  reason  or  memory,  and  concluded 
that  his  conduct  was  simply  vicious. 

These  facts  describe  conditions  and  symptoms  that  are 
not  well  known,  but  exist  in  a  certain  proportion  of  all 
inebriates  and  persons  who  use  spirits.  The  change  of 
character  and  the  failure  of  the  last-formed  faculty  of  the 
brain,  termed  the  "ethical  sense"  of  right  and  wrong,  is 
characteristic  of  the  action  of  alcohol. 

In  addition  to  this,  there  is  a  class  of  persons  in  whom 
this  ethical  sense  is  wanting  or  very  feebly  developed 
before  alcohol  is  taken.  In  such  persons  the  use  of 
spirits  would  simply  intensify  and  increase  the  previous 
degeneration ;  and  it  is  persons  of  this  class  which  fur- 
nish the  largest  number  of  recruits  of  low  criminals. 

No  matter  what  the  previous  condition  has  been,  in- 
ebriety signifies  a  special  and  pronounced  damage  of  the 
ethical  sense  which  may  be  termed  moral  palsy. 

Studies  of  drinking  men  bring  out  this  fact,  and  show 
that  no  matter  what  the  other  forms  of  degeneration  are, 
this  peculiar  defect  is  always  present.  Whether  this  is  a 
transient  palsy  due  to  physical  changes  or  whether  it  is  a 
permanent  cutting-off  and  breaking  down  of  some  func- 
tional activity,  is  disputed.  Many  authors  consider  it  an 
inherited  condition  and  seen  only  in  persons  whose  an- 
cestors have  been  diseased. 

The  practical  character  of  this  phase  of  inebriety  comes 
out  in  the  question  of  responsibility  for  crime  and  con- 
duct that  is  unusual  and  antagonistic  to  law  and  order. 
Many  interesting  questions  call  for  an  answer;  thus,  is  it 
possible  for  one  to  use  alcohol  either  as  a  constant  or 


10-i  INEBRIETY. 

periodic  drinker,  and  retain  his  former  consciousness  of 
duty,  obligation  to  himself  and  others? 

In  pronounced  toxic  states  from  spirits  this  conscious- 
ness is  evidently  wanting.  Is  it  possible  to  recover  fully 
this  ethical  sense  of  right  and  wrong  after  repeated  toxic 
states?  These  are  some  of  the  questions  which  can  only 
be  answered  by  a  study  of  accurately  observed  facts,  and 
not  from  theories  or  opinions. 

So  far,  the  moral  palsies,  so  common  in  all  inebriates, 
are  very  significant  symptoms  that  should  be  recognized 
and  studied  in  every  effort  towards  prevention  and  cure. 


CHAPTER  XI. 

GENERAL  CAUSES  AND  FAVORING  CONDITIONS. 

Synopsis. —  Explanations  of  the  causes  very  numerous.  Each 
patient  feels  competent  to  explain  the  causes  in  his  case.  Ego- 
tism a  common  symptom.  Loss  of  pride  and  character  another 
symptom.  Physical  exhaustion  often  precedes  the  drink  stage. 
Heredity  a  very  active  cause.  Nervous  diseases  indigenous.  Al- 
cohol most  grateful  remedy.  Children  given  wine  in  early  .life 
have  a  predisposition  later  to  use  spirits.  Persons  with  bad  train- 
ing. The  alcoholic  impulse  is  grown  and  cultivated.  It  may  ap- 
pear suddenly.  It  may  break  out  in  middle  life  from  causes  that 
are  dormant.  It  may  appear  any  time  from  some  change  in  the 
brain.  Obscure  conditions  may  be  active  causes.  Diet  important 
and  active  as  an  exciting  cause.  Periods  of  life  when  it  is  more 
likely  to  break  out.  Shock  of  the  first  intoxication  leaves  an 
entailment.  Symptoms  of  drink  neurosis.  Psychic  symptoms.  The 
demand  for  alcohol  and  relief  which  it  brings.  Danger  of  using 
alcohol  as  a  remedy.  Unknown  vitality  and  resisting  power.  Early 
physical  impressions  continue  in  after  life.  Examples.  Alcohol 
dangerous  in  aged.  General  considerations. 

It  is  a  curious  fact  that  the  inebriate  and  his  friends 
have  unusual  confidence  in  their  ability  to  explain  the 
causes  which  impel  men  to  drink,  and  explain  the  reasons 
why  spirits  were  first  taken.  This  is  one  of  the  few 
disorders  in  which  almost  everyone  has  an  opinion  and 
feels  very  free  to  express  it,  at  all  times  and  upon  all 
occasions. 

In  a  work  on  "Drunkenness,"  published  some  time  ago, 
the  author  made  very  prominent  the  causes  and  the  exact 
reasons  why  spirits  are  taken.  Among  other  things  were 
mentioned  heat,  cold,  hunger,  thirst,  weakness,  anger, 
sorrow,  loss,  success,  death,  birth,  overwork,  no  work, 
want  of  sleep,  and  so  on ;  covering  nearly  every  condition 
of  life  and  occupation. 

The  author  was  so  impressed  with  the  accuracy  of  his 
studies  that  he  seemed  to  fairly  revel  in  details  and  ex- 
planations of  how  and  why  the  drink  impulse  developed. 

105 


106  INEBRIETY. 

He  was  very  confident  that  the  judgment  of  a  large  num- 
ber of  inebriates  furnished  the  most  accurate  data  in  the 
study  of  causes  and  motives  which  impelled  the  drink 
craze. 

His  book,  like  many  others,  contained  evidence  that  the 
author  himself  was  a  victim,  and  was  simply  enlarging 
his  experience.  If  the  study  of  insanity  was  based  on 
the  opinions  of  insane  men,  and  their  motives  and  con- 
ceptions, it  would  be  very  confusing  and  doubtful,  and 
the  explanations  of  the  causes  would  vary  with  each  in- 
dividual. 

In  much  the  same  way  the  inebriate  who  describes  with 
minuteness  how  the  first  use  of  spirits  began,  and  the 
conditions  which  favored  its  continuance  is  not  likely  to 
be  accurate.  Literally,  very  few  inebriates  can  give  any 
rational  reason  why  spirits  were  used  at  first,  although 
afterwards,  while  under  the  influence  of  spirits,  they  are 
very  profuse  in  their  reasons  and  explanations. 

On  recovery  these  are  forgotten,  and  the  patient  ac- 
knowledges his  inability  to  tell  why,  or  give  any  clear 
explanation  as  to  how,  he  first  began  to  use  spirits. 

Occasionally  a  person  is  conscious  of  intense  pleasure 
from  the  effects  of  the  spirits,  and  of  his  inability  to  resist 
its  use.  Many  persons  take  spirits  for  the  first  time 
without  any  thought  of  its  danger,  which  they  never  real- 
ized fully  until  in  later  stages  when  an  effort  is  made  to 
give  it  up. 

Most  inebriates  have  a  very  faint  idea  of  the  danger 
from  the  use  of  spirits,  and  the  struggle  to  abstain  is  a 
mere  matter  of  promises ;  words  with  a  delusive  confidence 
in  their  ability  to  control  the  desire. 

The  explanations  offered  by  the  inebriate,  of  how  he 
became  addicted  and  how  he  can  escape,  are  most  unreal ; 
and  yet  they  are  accepted  by  his  friends  and  associates 
as  practical  facts. 


GENERAL  CAUSES  AND  FAVORING  CONDITIONS.     107 

The  egotism  of  inebriates  is  one  of  the  first  signs  of 
degeneration.  This  occasionally  merges  into  mania  or 
slight  forms  of  melancholia.  It  has  been  stated  by  many 
authors  that  all  inebriates  are  both  maniacal  and  melan- 
choly, and  the  evidence  on  which  this  is  based  is  strikingly 
confirmed  in  many  instances. 

In  a  study  of  a  large  number  of  inebriates,  there  ap- 
pear to  be  two  distinct  ranges  of  causes  prominent;  one 
of  general  physical  and  psychical  exhaustion  that  has 
preceded  and  follows  from  the  use  of  spirits;  the  other, 
some  distinct  constitutional  degenerations  and  defects  due 
to  heredity  or  physical  and  psychical  causes  existing  long 
before  spirits  are  taken. 

A  large  number  of  persons  in  the  first  class  exhibit  a 
history  of  distinct  physical  disorders,  particularly  dys- 
pepsia, bad  nutrition  and  exhaustion  from  unhygienic 
methods  of  living.  Persons  who  are  burdened  with  care 
and  worry,  and  who  suffer  from  continuous  nerve  and 
muscle  strain,  are  marked  examples. 

Thus  speculators,  merchants,  mechanics,  artisans,  farm- 
ers, and  workmen  who  are  struggling  for  bread  and 
wealth,  and  endeavoring  to  accomplish  some  particular 
purpose,  and  find  great  difficulties  in  adapting  themselves 
to  the  changing  conditions ;  also  persons  who  carry  great 
loads  of  care  and  responsibility,  or  men  with  limited  in- 
comes and  large  families ;  who  are  perpetually  strained 
to  provide  for  the  necessities  of  life,  and  whose  constant 
thought  is  the  fear  of  failure.  Ambitious  men,  who  are 
straining  every  nerve  to  attain  their  desire ;  and  avari- 
cious men,  struggling  to  pile  up  money ;  and  so  on, 
through  the  list  of  almost  every  condition  of  life,  with  its 
burdens  and  responsibilities ;  there  are  states  of  exhaus- 
tion and  debility  which  call  for  relief  from  some  source. 
The  effects  of  this  constant  strain  and  struggle  is  marked 


108  INEBRIETY. 

by  exhaustion,  irritability  and  general  weakness,  both 
muscular  and  mental. 

Alcohol,  of  all  other  drugs,  gives  the  most  delusive 
relief,  through  its  narcotic  action;  and  this  is  interpreted 
as  permanent  help,  and  so,  in  a  short  time,  the  remedy  is 
used  continuously. 

Its  accumulative  action  not  only  covers  up  the  exhaus- 
tion, but  develops  toxic  states  for  farther  and  more  pro- 
found debility. 

There  is  another  class  in  this  country  whose  life  and 
training  prepares  them  for  inebriety  and  drug-taking. 
They  are  persons  who  suffer  from  idleness  and  hyper- 
nutrition  and  become  poisoned  and  debilitated.  They  are 
persons  without  occupation  and  without  exercise,  who 
overeat,  and  from  the  toxaemic  states  from  food  find  relief 
in  spirits  and  beer. 

Opium,  when  taken  to  relieve  pain,  is  sometimes  con- 
tinued unless  its  effects  are  disturbing,  but  spirits  are  the 
most  common  remedies  which  give  relief  and  cover  up  the 
toxic  conditions. 

Another  class  because  of  unhygienic  surroundings,  badly 
ventilated  rooms,  workshops,  factories  and  homes,  suffer 
from  states  of  starvation  and  cell  poisoning,  which  are 
the  favorite  soil  for  the  growth  of  inebriety. 

Occupations  that  require  incessant  readjustment  of 
those  engaged,  to  accommodate  themselves  to  the  new 
conditions,  often  produce  the  same  effect.  Alternations 
of  heat  and  cold  and  continuous  changes,  experienced  by 
traveling  men  and  persons  engaged  in  steamboating  and 
railroading ;  or  occupations  where  fear  is  always  dom- 
inant and  continuous  emotional  strain  is  present,  always 
react  in  exhaustion  and  distress,  from  which  inebriety 
follows  most  naturally. 

It  must  not  be  inferred,  that  these  very  general  condi- 
tions of  exhaustion  which  depress  and  lower  the  vitality 


GENERAL  CAUSES  AND  FAVOBING  CONDITIONS.     109 

of  the  body,  always  end  in  an  intense  desire  for  alcohol, 
or  in  inebriety.  It  is  only  intended  to  show  that  a  large 
number  of  persons  who  drink  to  excess  do  so  from 
physical  exhaustion,  which  precedes  the  use  of  spirits. 

This  number  is  so  large  that  these  causes  can  be  ra- 
tionally considered  as  most  frequent  in  both  predisposing 
and  exciting  inebriety.  Of  course,  there  is  always  a  cer- 
tain number  of  persons  to  whom  alcohol  is  distinctly  re- 
pellant  and  painful,  and  with  whom  it  does  not  act  as  a 
narcotic  at  first.  That  this  condition  can  be  overcome  by 
its  continued  use  is  sustained  by  experience. 

An  English  author  wrote  at  some  length  to  show  that 
the  first  effects  of  alcohol,  increasing  the  circulation  of 
the  blood  in  the  brain,  was  painful  and  depressant  and 
that  its  narcotic  action  was  exceptional.  He  argued  from 
this  that  the  use  of  alcohol  had  to  be  cultivated,  and  no 
previous  condition  would  make  it  attractive  from  the  first. 
This  has  not  been  confirmed  by  experience. 

It  is  safe  to  assume  that  the  narcotic  action  of  alcohol 
is  certain  to  be  pleasing  and  attractive  where  conditions 
of  exhaustion  prevail,  hence  these  may  be  called  causes. 

A  second  range  of  causes  may  be  grouped  under  the 
term  hereditary,  constitutional  conditions,  which  will  be 
discussed  in  some  detail  in  other  chapters,  but  at  present 
will  be  merely  outlined.  Thus,  in  a  large  and  variable 
percentage  of  cases  in  which  inebriety  is  present,  there 
is  a  distinct  neurotic  and  psychopathic  condition,  which  is 
traceable  to  the  ancestors,  and  is  clearly  transmitted  to 
the  next  generation. 

In  this  class  there  are  very  marked  histories  of  nutrient 
disorders  in  childhood,  physical  defects,  infantile  diseases 
which  are  particularly  serious  and  followed  by  serious  en- 
tailments. 

Infantile  diseases,  in  the  children  of  inebriates,  are 
always  more  severe;  and  inflammatory  conditions,  from 


110  INEBRIETY. 

the  slightest  causes,  are  prominent.  Frequently  the  men- 
tality of  the  child  is  marked  by  great  extremes,  either  of 
precosity  or  dullness,  or  the  child  may  seem  very  irritable, 
and  excessively  sensitive  and  impulsive. 

At  puberty  many  complex  symptoms  appear  which  are 
confusing,  and  attended  with  low  vitality,  hyperasthesia. 
It  is  at  this  time  that  alcohol  is  found  to  be  a  most  sooth- 
ing medicine,  no  matter  in  what  form  it  may  be  given ; 
and  later  it  becomes  a  beverage,  and  then,  a  train  of  de- 
generation begins,  which  ends  in  inebriety. 

It  often  happens  that  children  of  neurotic  and  mod- 
erate drinking  parents  are  given  wine  and  beer  in  child- 
hood, often  as  a  medicine,  on  the  theory  that  it  has  some 
food  elements.  This  fixes  the  inebriate  tendency,  and 
develops  a  predisposition,  which  is  almost  certain  to  break 
out  in  later  life,  with  or  without  any  visible  exciting 
causes. 

Children  of  this  class,  who  are  subjects  of  intense  solici- 
tude and  overcare  by  parents  and  who  are  trained  to 
depend  on  drugs  and  medicine  to  overcome  discomforts 
and  suffering,  are  being  prepared  for  inebriety,  which 
in  all  probability  will  break  out  in  the  future. 

Proprietary  medicines,  given  in  childhood,  particularly 
tinctures  and  narcotic  compounds,  have  the  same  effect 
in  preparing  the  soil  and  making  it  possible  for  inebriety 
in  the  future. 

Common  examples  are  seen  in  almost  every  community, 
where  nervous,  feeble  children  from  neurotic  and  mod- 
crate-drinking  parents  are  the  subject  of  continuous 
medical  care,  and  who  are  taken  to  Europe,  and  travel 
about  the  country  for  the  purpose  of  securing  more 
vigor  and  strength ;  practically  overfed  and  always  over- 
dosed. 

Such  children,  when  they  grow  up  and  pass  through 
college,  as  a  rule,  become  inebriates.  Wine  drinking  for 


GENERAL  CAUSES  AND  FAVORING  CONDITIONS.     Ill 

strength  and  exhilaration,  and  then  for  sociability,  quickly 
develops  into  pronounced  inebriety.  In  this  class  are  in- 
cluded persons  who  are  supposed  to  be  trained  as  total 
abstainers,  and  yet  hygiene  of  the  nervous  system  has 
been  utterly  disregarded  in  their  education. 

The  boy  who  has  been  trained  a  rigid  abstainer,  may  be 
a  psychopath,  and  suddenly,  under  any  circumstances,  be 
overcome  by  a  drink  impulse,  and  use  alcohol  to  great 
excess.  Frequently  such  cases  are  the  wonderment  of  the 
friends,  who  suppose  that  simply  temperance  training  in 
early  life  would  secure  an  immunity  from  an  alcoholic 
breakdown  in  the  future;  the  heredity  is  not  understood. 

Some  very  interesting  instances  have  been  noted  of  the 
breaking  out  of  the  drink  impulse  at  most  unexpected 
times  and  places. 

It  appears  in  some  cases  that  there  must  be  some  con- 
ditions that  may  be  atmospheric  or  electrical,  and,  at  all 
events,  controlled  by  forces  entirely  unknown,  which  bring 
on  this  drink  impulse  at  the  sea  level  or  in  the  mountains. 

A  number  of  cases  have  been  noted  where  these  heredi- 
tary neurotics  drank  only  at  the  seashore  or  at  some  high 
mountain  levels.  At  other  places  they  were  able  to  con- 
trol the  desire  and  be  free  from  all  use  of  spirits. 

Often  indiscriminate  education  applied  without  ref- 
erence to  a  neurotic  and  nervous  organization  develops 
psychopathic  degenerations,  which  lead  up  to  spirit  and 
drug  taking.  This  is  a  very  frequent  history  of  many 
cases  who  are  very  highly  trained  along  lines  that  favor 
exhaustion,  bad  living  and  irregular  development,  and 
this  is  almost  sure  to  end  in  this  way. 

It  is  this  sort  of  education  and  training,  outside  of 
natural  adaptation  and  capacity  and  without  reference  to 
hereditary  entailments,  that  results  in  a  poor  doctor,  a 
weak  minister,  a  feeble  lawyer,  and  a  slack  business  man ; 


INEBRIETY. 


whose  entire  life  is  a  failure,  with  inebriety  and  drug 
taking  as  a  frequent  possibility. 

In  such  persons  there  is  continual  disappointment,  in- 
evitable, from  their  ill  adaptation  to  the  circumstances; 
and,  as  a  result,  there  is  low  vitality,  insomnia  and  va- 
rious conditions  that  naturally  call  for  a  narcotic,  of 
which  spirits  is  the  most  prominent. 

Many  writers  have  called  attention  to  the  influence  of 
diet  in  early  life,  as  an  active  cause  for  the  use  of  alcohol 
later. 

The  late  Dr.  Wright  traced  this  condition  in  a  large 
number  of  instances,  and  concluded  that  the  inebriety  of 
middle  life  was  very  often  traceable  to  faulty  nutrition 
in  infancy. 

The  late  Drs.  Parker,  Parish  and  Wilson,  from  long 
experience  with  the  wealthy  classes,  reached  the  same  con- 
clusions. In  such  cases  there  are  clearly  over-stimulation 
in  infancy  and  childhood  ;  the  diet,  excessively  rich  in 
proteids  and  albumenoids,  soon  breaks  up  the  metabolic 
equilibrium,  which  is  never  fully  restored. 

Thus,  toxic  poisonings,  beginning  in  infancy,  go  on 
through  various  stages  ;  and  the  balance  between  waste 
and  supply  is  disturbed,  and  the  perversions  and  derange- 
ments become  more  intense  and  organic.  For  these  dis- 
turbances, drugs  are  used,  and  alcohol  is  the  most  prom- 
inent sedative. 

On  the  other  hand,  where  nutrition  is  defective  and 
poor  in  quality,  or  from  some  peculiar  notions  special 
foods  are  used,  similar  results  follow,  of  which  mal- 
nutrition and  starvation  are  prominent.  There  is  no 
doubt  that  both  classes,  those  who  suffer  from  an  alcoholic 
heredity,  and  those  who  have  no  entailment  of  this  kind, 
are  largely  influenced  by  the  nutrition  of  childhood. 

It  is  an  interesting  question,  on  which  authorities  differ, 
namely,  how  far  tea  and  coffee,  used  in  early  life,  favor 


GENERAL  CAUSES  AND  FAVORING  CONDITIONS.     118 

depressions  and  perversions,  which  finally  lead  up  to  the 
drink  impulse.  There  can  be  no  doubt  that  they  are 
causes,  both  active  and  predisposing,  in  a  certain  number 
of  cases. 

A  great  variety  of  evidence  has  been  published,  show- 
ing the  influence  of  tea  and  coffee  in  early  childhood, 
and  its  special  predisposing  tendencies  to  the  use  of  al- 
cohol in  later  life.  Dr.  Mason  has  given  some  striking 
examples  in  his  studies  of  cases  treated  at  the  Fort  Ham- 
ilton Inebriate  Home,  particularly  of  persons,  who  after 
the  use  of  spirits  in  infancy7,  were  total  abstainers  until 
middle  or  later  life,  and  then  became  inebriates. 

One  example  was  a  boy  who  was  treated  with  spirits 
and  wine  for  several  months  in  early  childhood  and  grew 
up  a  total  abstainer  until  about  thirty  years  of  age. 
Spirits  were  given  for  insomnia  at  first.  In  later  life  a 
severe  attack  of  pleurisy  came  on,  and  with  it  an  inpulse 
to  use  spirits  which  he  was  unable  to  resist. 

Another  example  was  a  boy,  who  from  some  heat  stroke 
in  early  life,  was  given  wine  or  spirits.  He  was  a  total 
abstainer  until  after  forty  years  of  age;  then,  while  con- 
valescing from  typhoid  fever,  a  craze  for  spirits  began, 
which  continued  until  his  death  a  few  years  later. 

These  and  other  cases  mentioned  showed  distinct  con- 
nections between  the  early  and  later  use  of  alcohol  which 
are  more  than  accidents. 

The  late  Dr.  Parish  reported  a  case  of  a  very  eminent 
man  who  was  treated  with  spirits  for  an  attack  of  typhoid 
fever  when  a  boy.  He  became  a  famous  teacher  of 
medicine  and  was  a  temperate  man  in  every  way,  and  yet 
whenever  exhausted  the  impulse  to  use  spirits  was  very 
pronounced.  Later  in  life  he  gave  way  to  this,  and  it 
was  found  that  he  became  profoundly  stupid  from  a 
small  quantity  of  spirits ;  at  other  times  spirits  were  re- 
pugnant. The  later  years  of  his  life  were  a  continuous 


11 4  INEBRIETY. 

struggle  to  avoid  exhaustion,  and  thus  abstain  from  the 
use  of  spirits. 

Belonging  to  the  same  range  of  causes,  and  illustrating 
the  wide  diversity  of  conditions  which  precede  the  drink 
craze,  are  the  following  examples.  A  young  man  without 
hereditary  predisposition  became  profoundly  intoxicated 
at  a  college  banquet.  Later,  when  a  clergyman,  whenever 
dining  with  a  large  company,  he  suffered  acutely  from 
an  impulse  to  drink  and  with  the  horror  and  vivid  im- 
pression of  the  first  attack.  He  finally  was  obliged  to 
keep  away  from  all  public  banquets  for  fear  he  should 
become  intoxicated. 

A  very  temperate,  vigorous  man,  who  became  wealthy 
suddenly,  drank  to  stupor  with  his  friends  in  celebration 
of  this  event.  For  years  afterwards  every  success  and 
special  exaltation  at  his  attainments  was  followed  by  an 
intense  desire  to  use  spirits. 

Another  example,  showing  the  opposite  effect,  was  of  a 
strong  business  man,  who,  though  thoroughly  temperate 
in  every  way,  yielded  to  the  solicitations  of  his  friends 
and  became  intoxicated  on  a  certain  occasion.  He  was 
intensely  nauseated  and  suffered  from  a  low  fever  for 
several  days  after.  Later,  the  odor  of  spirits  was  fol- 
lowed by  nausea  and  intense  disgust,  and  the  rest  of  his 
life  he  was  unable  to  attend  dinners  where  wine  was 
used,  or  to  stay  in  the  company  of  persons  who  were 
drinking,  and,  when  obliged  to  do  so,  went  home  and 
suffered  from  a  low  form  of  fever. 

A  lawyer,  who  drank  heavily  during  his  colleg3  ca- 
reer, suddenly  developed  the  utmost  horror  and  exhaus- 
tion from  the  sight  and  smell  of  spirits,  and  had  to  go 
to  bed  whenever  he  came  in  contact  with  drinking  men 
for  any  length  of  time. 

There  was  in  this  something  more  than  a  mental  obses- 
sion. There  was  both  a  psychological  and  psysiological 


GENEEAL  CAUSES  AND  FAVORING  CONDITIONS.     115 

aversion,  which  depressed  him  in  a  remarkable  way.  Fa- 
miliar illustrations  are  those  of  persons,  who,  after  pro- 
found fatigue  and  weariness,  are  given  alcohol  medici- 
nally, and  the  pleasing  effects  leave  an  impression  on  all 
later  life. 

Such  persons  frequently  become  intoxicated  on  the  re- 
currence of  any  special  fatigue.  In  the  meantime,  they 
are  total  abstainers  and  abhor  the  condition  which  follows 
from  fatigue.  Persons  who  have  had  unusual  toxic  effects 
from  spirits  are  often  noted  for  the  intensity  of  their 
efforts  to  help  others  avoid  similar  conditions. 

Examples  like  the  following  are  not  uncommon:  An 
inebriate,  after  years  of  drinking,  becomes  restored,  and 
at  intervals  he  makes  herculean  efforts  to  help  others  who 
are  in  like  condition.  He  will  leave  his  business  and 
family  and  follow  the  poor  victim  with  an  intensity  that 
is  unexplainable,  to  bring  him  back  to  sobriety  again. 

A  noted  business  man,  after  the  arduous  work  of  the 
day,  spends  his  evenings  in  conducting  temperance  re- 
vivals in  the  slum  districts  until  after  midnight.  When 
not  holding  such  meetings,  he  is  visiting  the  homes  of 
drinking  men  and  begging  them  to  abstain. 

A  young  lawyer  of  great  promise  suddenly  stops  all 
business  and  becomes  a  reformer.  Years  afterwards  he 
explains  his  motive  by  saying  that  if  he  had  not  gone 
into  the  work  of  helping  others  he  would  have  died  a 
drunkard.  The  obsession  to  drink  was  so  powerful  that 
the  only  way  he  could  control  it  was  by  striving  to  help 
others. 

These  causes  are  so  complex  that  it  is  impossible  to 
give  more  than  an  outline  of  them.  Cases  like  the  fol- 
lowing are  met.  Drinking  men  who  develop  neuritis  and 
palsy,  stop  the  use  of  spirits  and  become  demented  or 
maniacal ;  or  inebriates,  who  have  cerebral  hemorrhage 


116  INEBRIETY. 

and  stop  using  spirits  show  a  degree  of  mental  vigor 
never  noticed  before. 

Persons  who  abstain  after  years  of  continuous  drink- 
ing become  paranoics  and  wild  reformers.  In  another 
chapter  we  shall  mention  tuberculosis  as  a  very  common 
sequel  of  excessive  inebriety.  Why  alcohol  develops  neu- 
ritis in  one  man,  dementia  and  profound  mental  weak- 
ness in  another,  gastro-intestinal  disease  and  organic  de- 
generation in  a  third,  and  in  the  fourth  presents  little  or 
no  evidence  of  disease,  except  general  debility,  is  yet  to 
be  studied. 

Why  total  abstainers,  or  men  and  women  who  have 
lived  practically  temperate  lives,  should  suddenly  develop 
inebrietry  without  any  active  or  exciting  causes,  is  equally 
mysterious. 

There  are  evidently  laws  of  degeneration  which  control 
the  cases,  and  there  are  clearly  effects  from  the  action  of 
alcohol  that  are  acute  and  accumulative  that  will  be  dis- 
covered in  the  future. 


CHAPTER  XII. 

SPECIAL  CAUSES  or  INEBRIETY. 

Synopsis. —  Occupations  among  the  special  causes.  Alcoholism 
caused  by  inhalation.  Some  examples.  Great  susceptibilities  in 
certain  surroundings.  Barometrical  conditions  are  often  pre- 
disposing causes.  Saloons  made  attractive  to  stimulate  thirst. 
Travel  and  excitement  dangerous  causes.  Moderate  use  of  beers 
and  other  beverages  lead  up  to  this  condition.  Neglect  of  physi- 
cal care.  Imperfect  diet.  Tea,  coffee  and  tobacco  often  influential. 
In  the  treatment  they  should  be  studied  carefully.  Cigarette 
smoking  dangerous.  Meat  eaters  more  liable  to  drink.  Depressed 
conditions  encourage  the  use  of  spirits  and  beers.  Children  im- 
perfectly nourished  find  great  relief  in  spirits.  Some  interesting 
statistics.  Examples  and  bad  training  frequent  causes. 

It  seems  best  to  try  and  group  the  great  variety  of 
causes  which  are  active  in  inebriety  under  different  head- 
ings, so  as  to  give  the  reader  a  better  conception  of  their 
complexity  and  afford  an  opportunity  to  discriminate  in 
future  studies. 

While  there  are  evidently  exciting  and  predisposing 
causes,  there  are  other  conditions  which  contribute,  give 
shape  and  form  to  the  degenerate  influences.  One  of 
these  is  the  question  of  occupation. 

Some  studies  recently  made  have  shown  that  persons 
engaged  in  the  manufacture  and  distribution  of  spirits 
furnish  a  large  number  of  inebriates.  Various  explana- 
tions have  been  given,  but  beyond  the  fact  that  drinking 
persons  are  more  or  less  attracted  by  such  employment, 
the  causes  are  not  clear. 

The  better  class  of  manufacturers  and  dealers  dis- 
courage and  try  to  prevent,  if  possible,  the  use  of  spirits 
among  persons  engaged  in  the  traffic.  This  is  no  doubt 
a  matter  of  business,  for  the  reason  that  the  users  of 
spirits  are  found  most  incompetent  and  unreliable,  and, 
therefore,  give  poor  service. 

117 


118  INEBRIETY. 

There  can  be  no  question  that  persons  working  in  the 
manufacture  of  spirits,  and  its  sale  and  distribution,  neces- 
sarily inhale  a  certain  amount  of  spirit  ethers  which,  after 
a  time,  impress  them  and  produce  toxic  states  of  exhaus- 
tion for  which  spirits  are  craved  as  a  relief  and  as  a 
medicine.  Instances  are  mentioned  of  persons  working 
in  distilleries  suffering  from  continued  impulses  to  take 
spirits. 

On  going  out  into  the  open  air  they  recover,  and  the 
impulse  dies  out.  The  same  is  noted  in  breweries  where 
persons  drink  beer,  but  do  not  drink  elsewhere.  Often 
retail  dealers  and  workers  manifest  intense  disgust  while 
handling  spirits,  and  have  no  desire  to  use  it  in  any 
way,  but  later,  when  away  and  not  engaged  in  the  work, 
have  pleasure  in  it  and  desire  to  drink. 

Both  of  these  conditions  are  very  marked.  One,  of  a 
distaste  while  working  in  contact  with  it,  and  the  other,  a 
fascination  for  it  and  a  desire  to  use  it,  which  are  not 
present  later.  Probably  a  majority  of  persons  working 
in  the  spirit  business  use  it  as  a  beverage  or  as  a  medi- 
cine, without  regard  to  the  external  circumstances. 

Formerly,  in  the  retail  business,  the  efficiency  of  the 
bar-keeper  was  determined  by  his  ability  to  drink  in 
moderation,  and  encourage  others  about  him  to  do  the 
same. 

Latterly,  the  value  of  a  bar-keeper  turns  on  his  total 
abstinence,  and  his  ability  to  remain  sober  and  take  ad- 
vantage of  the  weakness  of  others.  It  is  a  boast  of  many 
men  in  the  business  that  they  are  able  to  drink  in  mod- 
eration and  never  to  excess,  but  experience  shows  that 
such  men  are  the  most  degenerate  of  all  classes  of  drink- 
ing men. 

Experience  also  shows  that  the  dealers  in  spirits  suffer 
from  rheumatism,  gout,  dyspepsia  and  organic  inflam- 


SPECIAL  CAUSES  OF  INEBRIETY.  119 

mations  of  the  stomach  and  kidneys,  and  are  health-seekers 
to  a  larger  degree  than  persons  in  other  occupations. 

Some  very  interesting  cases  have  been  published  in  The 
Journal  of  Inebriety  of  "Alcoholism  from  Inhalation  of 
Spirit  Odors,"  in  persons  who  have  been  total  abstainers. 
One  instance  was  that  of  a  clerk  with  a  wife  and  family 
of  four  children  who  lived  in  an  apartment  over  a  room 
where  spirits  were  mixed  for  sale. 

His  wife  and  family  suffered  from  headaches,  stupor, 
insomnia,  faulty  nutrition  and  general  invalidism.  All 
treatment  was  ineffectual.  Finally  they  moved  to  another 
apartment  and  recovered.  It  was  clear  that  the  odors 
from  the  spirits  below  penetrated  through  the  ceiling  and 
became  a  constant  source  of  poisoning. 

This  was  confirmed  by  the  fact  that  the  wife  and 
children  suffered  more  than  the  husband,  who  was  out 
during  the  day,  and  during  the  winter,  when  the  doors 
were  closed,  they  were  worse  than  at  other  times.  Exam- 
ples of  persons  who  were  strong  and  healthy,  doing  busi- 
ness in  warehouses  where  spirits  were  stored,  suffering  first 
from  headache,  derangement  of  the  stomach,  nervous  de- 
pression and  a  great  variety  of  complex  symptoms,  which 
gradually  led  up  to  the  use  of  spirits,  have  been  noted 
in  many  journals. 

Some  of  the  palatial  bar-rooms,  where  there  are  foun- 
tains of  perfumed  water  and  spirit  odors  pervade  the 
air,  it  is  noticed  that  they  create  the  sensation  of  thirst 
and  desire  to  drink  in  those  in  whom  it  did  not  exist  be- 
fore. The  retailer  has  studied  this  art  of  appealing  to 
the  sense  of  smell  by  filling  the  air  with  spirit  odors,  and 
sometimes  scattering  it  on  the  street  in  front  of  the  saloon 
to  arouse  a  desire  in  the  minds  of  the  persons  who  are 
passing  by. 

There  is  no  doubt  a  hypersensitiveness  to  spirit  odors 
in  many  persons,  particularly  in  those  who  have  used 


120  INEBRIETY. 

spirits  formerly.  Thus  the  smell  of  wine  at  the  com- 
munion table,  or  its  taste,  has  often  been  followed  by  an 
intolerable  desire  to  drink. 

Instances  are  noted  where  persons,  previously  tem- 
perate, have  been  attracted  by  the  highly-flavored  odors 
of  wine,  and  have  drunk,  ending  in  intoxication.  It  is 
not  clear  that  appeals  to  the  sense  of  smell  in  this  way 
have  caused  inebriety  in  a  previously  temperate  man,  but 
there  are  innumerable  instances  where  these  conditions 
have  preceded  the  use  of  spirits,  and  it  is  very  certain 
that  the  odors  of  spirits  to  men  who  have  previously  used 
them  to  great  excess  is  a  special  exciting  cause. 

The  art  of  selling  spirits  has  been  developed  to  a  very 
high  degree  in  the  luxury  and  artistic  attractiveness  of 
saloons.  Appeals  to  the  senses,  particularly  to  the  sight, 
smell  and  hearing,  in  warm,  attractive  surroundings,  may 
be  made  to  increase  the  thirst  and  provoke  a  desire  to 
drink. 

Some  very  curious  facts  have  been  worked  out,  showing 
that  the  traffic  in  spirits,  both  wholesale  and  retail,  has 
some  peculiar  psychical  degenerative  influences ;  and  that 
men  engaged  in  the  business,  not  total  abstainers  and 
called  temperate,  always  suffer  in  the  end  from  disease, 
both  mental  and  physical,  that  in  some  way  seems  to  date 
from  the  business. 

Examples  are  cited  of  persons  of  good  average  mental 
and  moral  vigor,  conducting  the  business  along  rational, 
common-sense  lines,  who  not  only  become  diseased  in  most 
unexpected  ways  but  suffer  in  some  degree  not  common 
to  other  occupations. 

It  is  very  evident  from  statistics  that  persons  engaged 
in  the  traffic  have  greater  mortality  and  are  more  liable 
to  disease  and  inebriety  than  others.  The  commercial 
traveler  of  former  times  suffered  very  largely  from  in- 


SPECIAL  CAUSES  OF  INEBRIETY. 


ebriety,  and  ranked  next  to  the  spirit  dealer  in  liability 
to  this  disease. 

The  causes,  irregularity  of  work  and  rest,  with  con- 
tinuous change,  mental  strain  and  habits  of  treating  after 
each  sale,  were  very  prominent. 

There  were  always  starvation  and  imperfect  nutrition 
from  the  irregular  life  of  this  work  that  found  in  alcohol 
a  most  grateful  relief.  Fortunately,  these  conditions  are 
passing  away,  and  the  old-time,  convivial  commercial  trav- 
eler is  disappearing,  and  the  total  abstainer  is  taking  his 
place.  Still  the  business  is  marked  by  special  exciting  and 
contributing  causes,  favorable  to  the  growth  and  produc- 
tion of  inebriety. 

Brokers  and  speculators  belong  to  a  class  where  con- 
tinuous strain  and  irregularity  of  living,  with  forms  of 
mental  shock  and  excitement,  very  naturally  are  followed 
by  depression  and  exhaustion,  for  which  spirits  are  found 
to  be  most  grateful. 

It  is  a  fact  of  some  interest  that  pneumonia,  Bright's 
Disease,  and  cerebral  hemorrhage  are  very  common  in 
persons  of  this  occupation,  particularly  those  who  have 
used  spirits  to  excess. 

Manias  for  wealth  are  always  associated  with  sudden 
and  intense  fears  and  hope,  strains  on  the  vitality  and 
shocks,  breaking  up  the  normal  physiological  equilibrium 
of  life.  For  the  exhaustion  which  follows  from  this, 
spirits  are  frequently  used. 

The  same  thing  is  seen  in  political  circles,  where  am- 
bitious men  make  great  struggles  for  position  and  power, 
and  suffer  from  a  constant  drain  on  the  emotions  and 
reasoning  to  attain  some  particular  point. 

Life  with  them  becomes  a  mania.  Here  the  same  con- 
ditions exist.  Many  examples  are  noted  where  previously 
temperate  men  have  entered  into  the  political  field,  and 


122  INEBRIETY. 

after  a  while  became  inebriates  and  died  from  acute 
disease. 

The  general  fact  may  be  stated  that  all  occupations, 
associated  with  great  irregularity  and  sudden  strains  and 
drains,  are  active  and  contributing  causes  to  the  use  of 
alcohol,  and  only  the  most  rugged,  healthy  brain  power 
can  endure  work  of  this  kind. 

We  have  elsewhere  mentioned  the  fatal  advice  given 
persons  who  show  signs  of  exhaustion  from  these  peculiar 
occupations  mentioned — to  travel  abroad.  The  result  is 
always  increased  degenerations,  particularly  if  wines  and 
spirits  are  used. 

A  very  prominent  writer  declared  that  no  neurotics  or 
exhausted  professional  men,  suffering  from  overwork  or 
undue  care,  should  ever  go  abroad  for  health. 

The  risk  of  contracting  wine  and  beer-drinking  addic- 
tions is  so  great  that  no  possible  good  could  overbalance 
it.  Another  fact  has  been  stated  by  several  authors,  and 
is  evidently  based  on  a  very  large  observation,  that  many 
young  men,  who  go  abroad  to  perfect  their  professional 
studies,  return  with  an  alcoholic  addiction  which  follows 
them  through  later  life. 

The  common  use  of  beer  and  wine  in  the  universities 
of  Europe  furnishes  a  very  dangerous  soil  for  the  growth 
of  drink  and  drug  disease,  especially  in  neurotics  and 
persons  with  a  predisposition  to  exhaustion  and  debility. 

One  cause  has  been  the  subject  of  considerable  litera- 
ture, not  at  all  conclusive,  viz. :  that  the  excessive  use  of 
tea  and  coffee  provokes  spirit  and  drug  taking. 

It  is  a  frequent  observation  that  both  tea  and  coffee 
are  used  to  great  excess  during  the  free  intervals  between 
the  impulses  to  drink,  and  they  evidently  supply  some 
need.  There  is  considerable  literature  showing  that  the 
excessive  use  of  tea  and  coffee  has  been  a  premonitory 
symptom  of  inebriety. 


SPECIAL  CAUSES  OP  INEBRIETY. 


Many  authors  are  confident  that  the  excessive  use  of 
these  beverages  provoke  toxic  effects  and  degenerations 
that  favor  the  use  of  spirits.  There  is  evidently  a  neu- 
rotic basis  and  favorable  soil  for  inebriety  in  persons  who 
use  excessive  quantities  of  tea  and  coffee,  and  very  often 
a  craving  for  these  is  a  pathological  symptom  of  great 
significance. 

A  study  of  many  cases  show  that  the  free  use  of  tea 
and  coffee  has  preceded  the  drink  craze.  Persons  give 
histories  of  having  been  great  coffee  drinkers,  and  from 
the  derangements  following,  found  relief  in  the  use  of 
spirits  ;  then  gave  up  the  former  and  used  the  latter. 

Undoubtedly  there  are  distinct  physiological  effects 
from  coffee,  and  also  from  tea,  that  produce  favorable 
soils  for  the  growth  of  inebriety;  and  it  may  be  safely 
said  that  the  excessive  user  of  these  is  in  danger  of  con- 
tracting the  addiction  of  spirits. 

Tobacco  is  to  be  regarded  very  much  in  the  same  way. 
Its  effects  are  more  pronouncedly  narcotic  and  sedative, 
and  its  excessive  use  favors  exhaustion  and  depression,  for 
which  spirits  are  a  most  grateful  remedy. 

An  extensive  literature  on  this  subject  has  been  pub- 
lished, mostly  addressed  to  popular  readers,  the  central 
facts  of  which  are  well  attested,  showing  that  the  narcot- 
ism from  tobacco  is  particularly  dangerous  to  neurotics 
and  active  brain  workers,  not  only  from  its  direct  pois- 
onous action,  but  from  its  potent  influence  in  increasing 
the  craving  for  spirits. 

Studies  of  hypertension  show  that  alcohol  increases 
this  condition  and  tobacco  diminishes  it.  Hence  the  grate- 
ful feeling  produced  by  smoking,  in  lowering  the  tension 
coming  from  the  use  of  alcohol. 

The  alternate  raising  the  tension  by  spirits  and  lower- 
ing it  by  tobacco  is  physiological  but  very  quickly  be- 


INEBRIETY. 


comes  pathological.  The  excessive  use  of  tobacco  is  fol- 
lowed by  depression  for  which  alcohol  brings  relief. 

It  is  noted  that  cigarette  smoking  is  the  most  danger- 
ous form  of  all  the  methods  in  which  tobacco  is  used. 
The  poisonous  effects  in  excessive  depression  are  more 
pronounced  than  in  any  other  use  of  tobacco.  The  evi- 
dence from  the  history  of  many  cases  shows  that  excessive 
cigarette  smoking  is  followed  by  inebriety. 

In  the  remedial  treatment  of  inebriety  cigarette  smoking 
is  a  very  pronounced  retarding  influence,  and  experience 
shows  that  unless  the  use  of  the  cigarette  is  abandoned, 
restoration  is  very  slow  and  often  impossible.* 

Gormandizing  and  hypernutrition  appear  to  be  special 
exciting  causes,  or  conditions  which  have  preceded  the 
use  of  spirits.  In  the  history  of  many  cases  there  is  evi- 
dence of  excessive  use  of  food,  particularly  meats  and 
proteids,  and  the  deranged  metabolism  which  follows  from 
this  finds  relief  in  spirits,  which  practically  cover  up  the 
disorder.  In  this  way,  proprietary  drugs  are  responsible 
for  the  development  of  spirit  drinking,  particularly  in 
persons  who  suffer  from  deranged  digestion  and  forms  of 
dyspepsia  that  are  not  influenced  by  the  ordinary  medic- 
inal measures. 

It  has  been  stated  on  good  authority  that  any  form  of 
spirits,  in  proprietary  drugs  or  otherwise,  is  exceedingly 
dangerous  in  persons  who  are  dyspeptic,  and  who  have 
been  gormands  and  excessive  meat  eaters.  Records  of  cases 
show  that  these  conditions  have  so  often  preceded  in- 
ebriety as  to  be  recognized  among  the  causes. 

A  large  number  of  persons,  particularly  brain  workers, 
and  also  manual  laborers,  suffer  from  a  great  variety  of 


•These  subjects  are  presented  in  my  work  on  Morphinism  and 
Other  Narcomanias,  published  by  Wm.  B.  Saunders  &  Co.,  Phil- 
adelphia, Pa. 


SPECIAL  CAUSES  OF  INEBRIETY.  125 

depressed  mental  and  physical  states,  which  seem  to  call 
for  stimulants  or  remedies  to  relieve  them.  Such  persons, 
acting  on  the  theory  that  there  are  in  nature  drugs  and 
remedies,  which,  if  known,  would  prevent  disorders  of 
this  kind,  very  quickly  develop  the  craze  for  drink. 

Their  credulity  in  testing  every  new  remedy  offered, 
prepares  the  way  for  the  narcotism  from  alcohol.  A  de- 
lusive faith  in  drugs  and  drug  effects  is  always  a  pre- 
curser  of  degenerations  and  a  distinct  intimation  of  se- 
rious psychosis  and  the  borderline  of  pronounced  in- 
ebriety. Elsewhere  these  facts  are  described  at  some 
length. 

Dr.  MacNichol,  of  New  York,  in  some  studies  on  school 
children  whose  retarded  growths  and  faulty  developments, 
apparent  in  early  life,  were  traced  to  the  use  of  wine  and 
beer  given  by  their  parents,  showed  that  starvation  and 
derangement  was  a  very  prominent  factor  in  the  etiology 
of  inebriety. 

He  indicated  farther  that  these  children,  who  were 
practically  starved  and  poisoned,  would  inevitably  be- 
come spirit  takers  in  later  life;  and  that  this  same  condi- 
tion would  occur  in  the  families  of  wealthy  people,  where 
children  are  overfed  and  deprived  of  fresh  air  and 
brought  up  under  unfavorable  unhygienic  conditions, 
and  that  these  cases  would  end  in  the  same  way. 

At  the  recent  Anti-Alcoholic  Congress  in  London,  Dr. 
Doczi,  in  a  paper  on  "Alcoholism  Among  Children  in 
Hungary,"  brought  out  the  same  fact  and  showed  that 
all  forms  of  spirits  in  early  life  were  special  exciting 
causes  of  inebriety  later. 

Instances  like  the  following  are  frequently  seen. 

A  child  was  given  beer  and  wine  freely,  as  a  medicine, 
in  infancy ;  grew  up  healthy  and  was  a  total  abstainer 


126  INEBRIETY. 

until  after  fifty  years  of  age.  Then  after  a  visit  to 
Europe  for  rest,  he  suddenly  drank  wine  to  great  excess 
and  died  an  inebriate  a  few  years  later. 

The  facts  which  these  and  many  other  examples  bring 
into  prominence  are  that  the  early  use  of  spirits  leave  an 
entailment  and  predisposition  which  are  likely  to  break 
out  in  later  life  from  the  slightest  exciting  causes;  also 
that  children  given  spirits  in  early  life  suffer  in  much 
the  same  way. 

A  noted  writer  made  a  study  of  persons  who  are 
distinctly  careless  of  the  ordinary  hygienic  care  of  the 
body,  neglecting  baths  and  proper  exercise.  This  he 
concluded  to  be  an  exciting  cause  of  inebriety.  He 
showed  from  very  well  marked  examples  that  defective 
elimination  was  followed  by  toxaemias  which  provoked  the 
use  of  spirits. 

There  are  many  reasons  for  believing  that  this  is  true, 
and  the  confirmation  comes  often  from-  the  active  treat- 
ment of  inebriates  where  elimination  is  made  the  prin- 
ciple object.  Many  chronic  cases  of  inebriates  are  prac- 
tically cured  by  measures  that  produce  drastic  elimina- 
tion, showing  that  toxaemia  is  an  exciting  as  well  as  pre- 
disposing cause.  This  will  be  presented  under  another 
topic. 

There  are  many  persons  who  are  very  susceptible  to 
the  surroundings.  They  are  generally  neurotics,  and 
while  in  fair  health  are  very  largely  influenced  by  those 
they  come  in  contact  with.  This  class  of  persons  are 
very  strongly  influenced  by  drinking  men  and  follow 
their  example,  simply  from  suggestion,  and  show  feeble 
power  of  resistance. 

This  is  called  contagion  from  example  and  contact,  and 
may  be  considered  a  distinct,  exciting  cause,  and  should 
be  considered  in  a  study  of  individual  cases.  Numerous 


SPECIAL  CAUSES  OF  INEBEIETY. 


examples  will  occur  to  the  reader  in  which  a  powerful 
personality  controls  others  and  forces  them  to  follow  his 
example  and  literally  spreads  inebriety  broadcast.  This 
subject  will  also  be  treated  in  another  chapter. 

There  are  other  causes,  many  of  them  prominent,  which 
are  physiological  and  psychological  forces  that  may  prac- 
tically be  said  to  culminate  in  this  disease. 


CHAPTER  XIII. 

INJURIES  AND  PSYCHOSES  WHICH  FOLLOW  FROM 
THE  Toxic  USE  OF  SPIRITS. 

Synopsis. —  Toxic  states  from  alcohol,  very  serious.  Two 
classes,  one  direct  injuries  following  intoxication,  the  other  ob- 
scure injuries,  from  the  same  cause,  breaking  out  later.  Ex- 
amples. All  types  of  neuropsychoses,  and  psychopathies.'  Early 
profound  intoxication,  and  subsequent  degeneration,  not  uncom- 
mon. Examples  given.  Intoxication,  a  concussion  of  the  brain. 
Imbecility  and  dementia.  Common  sequel;?.  Phenomena  of  in- 
toxication. That  of  irritation  and  paralysis.  Symptoms  following. 
Recovery  slow.  Time  of  life  makes  a  difference.  Summary  of 
the  important  facts. 

The  history  of  many  inebriates  dates  back  to  very 
serious  organic  changes  arising  from  concussions,  blows 
on  the  head,  shocks  from  injuries,  falls,  heat  and  sun- 
strokes, and  syphilis. 

Often  the  connection  between  these  causes  and  the  in- 
inebriety  which  follows  is  very  clear,  and  can  be  traced 
with  great  distinctness.  In  other  cases  it  is  obscure,  with 
long  intervals  of  sobriety,  and  apparent  health.  Then, 
unexpectedly,  very  serious  changes  follow,  in  which  in- 
ebriety is  a  very  prominent  symptom. 

Alcoholic  intoxication,  meaning  the  delirium  or  stupor 
from  the  poison  of  excessive  use  of  spirits,  is  the  first 
cause  of  an  obscure  neuropsychosis,  and  the  future  con- 
tinuous use  of  spirits,  although  not  often  recognized, 
dates  from  this  event. 

Familiarity  with  states  of  intoxication  and  the  delusive 
theories  of  moral  causes  have  prevented  any  general  study 
of  the  first  effects  of  the  poisoning,  and  the  relation  be- 
tween them  and  the  subsequent  toxic  states  which  may  go 
on  for  years  at  long  intervals ;  hence,  the  etiology  of  the 

delirious   and   stupid   inebriates   seen   on   the   streets   or   in 
128 


INJURIES  AND  PSYCHOSES.  129 

the  station-house  is  practically  unknown,  each  case  being 
treated  simply  as  a  moral  lapse. 

There  is  a  distinct  psychosis  of  inebriety  which  may  be 
divided  into  various  classes.  First,  persons  with  a  his- 
tory of  injury,  followed  by  debility,  degeneration  and 
alcoholic  poisoning;  second,  where  some  acute  degenera- 
tion followed  from  the  first  use  of  spirits. 

As  an  example  of  the  latter  the  following  may  be  men- 
tioned. A  physician  became  intoxicated  and  his  condition 
was  so  alarming  that  many  medical  men  were  called  in. 
He  was  found  to  have  drunk  different  kinds  of  wine  at  a 
banquet,  and  immediately  became  convulsive  and  passed 
into  a  stupor. 

In  his  previous  life  he  had  been  strong  and  healthy, 
and  a  total  abstainer,  and  expressed  great  dislike  for  the 
taste  and  odor  of  spirits.  This  was  his  first  intoxication. 
He  recovered  in  the  course  of  a  few  days  and  complained 
of  great  exhaustion  and  debility.  Shortly  after  he  began 
to  suffer  extremely  from  dyspepsia,  was  anaemic  and  de- 
pressed, ate  to  great  excess,  was  frequently  exhausted, 
had  attacks  of  insomnia  and  headaches,  and  his  ordinary 
practice  was  a  great  burden. 

He  was  filled  with  morbid  fears  of  mistakes  and  loss 
of  reputation.  His  condition  was  diagnosed  as  neuras- 
thenia, and  possible  brain  exhaustion  and  dementia,  and 
advised  to  take  a  change  and  rest. 

He  went  abroad  and  came  back  with  the  wine-drinking 
habit.  He  was  morbidly  introspective,  and  alarmed  at 
the  possibility  of  a  malignant  disease  of  the  stomach. 
His  anaemia  increased.  He  ate  to  great  excess  for  a 
time  and  then  abstained. 

His  wine  drinking  was  of  the  same  erratic  character. 
Various  functional  disorders  frightened  him  so  seriously 
that  he  would  go  to  bed  and  drink  wine  for  days  at  a 
time.  Ke  had  a  morbid  fear  of  being  intoxicated,  and 


130  INEBRIETY. 

whenever  wine  affected  him  in  a  very  marked  way,  he 
would  abstain.  This  complex  condition  grew  until  finally 
one  day  he  drank  large  quantities  of  spirits  and  was 
found  dead. 

Another  example  was  also  of  a  physician,  who  passed  a 
rigid  examination  for  life  insurance  and  who  was  con- 
sidered a  very  healthy  man,  of  good  heredity,  with  no 
history  of  using  spirits  or  tobacco.  He  had  never  been 
sick  in  his  life,  and  was  supposed  to  have  taken  unusual 
care  of  himself. 

On  returning  from  a  consultation  he  was  caught  in  a 
snow  drift,  and  with  great  difficulty  made  his  way  to  a 
farmhouse,  thoroughly  chilled  and  exhausted.  His  con- 
dition was  so  serious  that  he  was  given  large  quantities 
of  cider  brandy.  To  the  astonishment  of  everyone  he 
became  delirious,  and  remained  in  this  condition  for  two 
days.  He  then  recovered  and  went  about  his  usual  work. 

From  this  time  his  manner  changed.  His  former  cheer- 
fulness merged  into  silence  and  reserve.  He  seldom 
laughed,  and  seemed  absorbed  in  some  mental  preoccupa- 
tion. He  complained  of  insomnia,  seemed  very  anxious 
about  foods  and  had  a  horror  of  baths. 

Six  months  later  his  condition  was  much  worse.  He 
walked  as  if  partially  paralyzed.  Both  digestion  and 
sleep  were  greatly  impaired.  He  made  no  complaint,  but 
went  about  as  usual.  When  asked  to  explain  his  condi- 
tion, spoke  of  it  as  obscure  nerve  exhaustion. 

Later  night-sweats  and  chills  were  considered  malaria, 
and  large  quantities  of  quinine  and  tinctures  of  drugs 
were  given  him.  The  diagnosis  was  brain  exhaustion, 
and  the  next  two  years  of  his  life  were  an  aimless  strug- 
gle passed  at  several  different  sanitoriums,  during  which 
he  drank  some,  but  never  to  stupor.  He  steadily  declined 
in  health  and  vigor  until  finally  he  died  in  some  convulsive 
condition. 


INJURIES  AND  PSYCHOSES.  131 

The  post-mortem  revealed  nothing  unusual,  and  there 
were  no  apparent  conditions  that  would  explain  the  cause 
of  death. 

A  third  example  was  a  clergyman  thirty  years  of  age, 
in  active  charge  of  a  large  church.  He  was  a  strong,  tem- 
perate, athletic  man,  never  using  spirits  or  tobacco,  and 
with  no  history  of  heredity  in  his  family.  He  became  chilled 
during  a  funeral  service  in  a  country  cemetery  in  the 
winter,  and  was  taken  into  a  neighboring  house  and  given 
quantities  of  brandy  and  milk. 

The  effects  of  this  produced  paralysis  of  the  lower 
extremities.  He  remained  in  bed  for  two  days,  in  a  semi- 
stupid  state  and  was  unable  to  walk.  He  then  recovered. 
Soon  after  nutrition  was  disturbed,  foods  distressed  him, 
tea  and  coffee  unduly  stimulated  him;  then  followed  in- 
somnia and  palpitation  of  the  heart.  Influenza,  malaria, 
rheumatism  and  various  forms  of  nervous  exhaustion  were 
diagnosed.  His  mind  became  feeble,  and  he  was  emo- 
tional and  unable  to  do  much  work. 

He  gave  up  his  charge  and  went  to  a  sanitorium,  where 
his  condition  gradually  grew  worse  until  his  death  from 
pneumonia,  two  years  after  the  intoxication. 

A  fourth  example  was  a  farmer  who  was  also  a  tem- 
perate man,  living  in  good  surroundings,  working  regu- 
larly every  day,  and  apparently  in  very  good  health. 
For  reasons  unknown  at  the  time  he  drank  champagne 
and  became  stupidly  intoxicated.  A  high  fever  followed, 
and  he  was  treated  for  incipient  typhoid  for  several 
months,  making  a  very  slow  recovery.  From  this  time 
on  he  was  an  invalid,  suffering  from  swelling  of  the 
joints,  acute  and  chronic  pains  in  the  extremities.  Two 
years  later  his  condition  was  more  serious,  principally 
neuritis  and  general  exhaustion. 

These  examples  are  very  marked  t}^pes  of  injuries  and 
neuropsychoses,  undoubtedly  due  to  the  toxic  action  from 


INEBRIETY. 


spirits.  In  all  probability  many  cases  less  prominent 
occur  in  which  the  first  use  of  spirits  is  not  regarded  as 
an  exciting  cause,  and  is  not  recognized  in  the  diagnosis. 

Some  of  these  cases  use  spirits  afterwards  as  a  medicine, 
either  as  a  proprietary  drug  or  as  some  form  of  wine 
or  beer.  In  all  there  is  no  indication  of  how  far  the  first 
paralysis  from  spirits  broke  up  the  normal  equilibrium  of 
nutrition  and  nerve  force. 

Persons  who  become  invalids,  exhibiting  complex  symp- 
toms that  are  diagnosed  by  general  vague  terms,  not  un- 
frequently  give  a  history  of  intoxication  and  recovery, 
and  soon  after  these  changes  appear. 

The  first  class,  where  a  history  of  some  injury  preceded 
the  use  of  spirits,  is  more  prominent  and  traceable,  but 
even  here  the  theories  of  the  causes  of  the  use  of  alcohol, 
so  widely  believed,  cover  up  the  real  causes  and  give  en- 
tirely different  impressions  of  the  nature  and  character 
of  the  events  which  follow. 

Many  persons  begin  to  use  spirits  suddenly  as  a  medi- 
cine or  for  some  frivolous  reasons,  and  later  become  in- 
toxicated, and  then  justify  their  use  of  spirits  from 
equally  marked  inefficient  causes.  A  noted  writer  said 
that  every  man  has  in  himself  the  history  of  his  family, 
or  rather  of  their  entailments  for  many  generations,  and 
the  causes  of  moderate  breakdowns  in  the  use  of  alcohol, 
may  be  referred  to  some  remote  ancestors,  or  to  some 
insignificant  injury,  either  in  his  life  or  his  parents',  which 
from  the  application  of  some  exciting  causes  break  out 
suddenly. 

A  very  prominent  example  occurred  recently  of  a  pre- 
viously healthy  man,  whose  eccentricities  and  genius  at- 
tracted great  attention.  Suddenly  he  became  profoundly 
intoxicated,  and,  on  recovery,  his  condition  was  diagnosed 
as  locomotor  ataxia.  He  remained  in  bed  for  a  year, 


INJURIES  AND  PSYCHOSES.  133 

drinking  continuously  until  death.  The  diagnosis  of 
palsy  was  obscure. 

In  the  clinical  study  syphilis  seems  to  be  a  very  com- 
mon early  history  preceding  the  use  of  drink.  Thus,  a 
man  previously  temperate  began  to  use  alcohol  to  cover 
up  the  depression  and  debility  following  an  attack  of 
syphilis.  Then  its  use  became  steady  and  regular.  Later 
he  died  from  dementia. 

Young  men  in  college,  who  contract  syphilis,  very  often 
begin  the  use  of  alcohol  as  a  medicine  to  cover  up  neuro- 
psychopathic  symptoms,  and  afterwards  become  chronic 
inebriates. 

In  the  practical  treatment  of  inebriates,  where  there  is 
suspicion  of  syphilis,  specific  treatment  very  often  clears 
up  prominent  symptoms  and  hastens  recovery. 

There  can  be  no  doubt  that  a  certain  number  of  cases 
of  inebriety  date  directly  from  the  injury  from  lues, 
and  that  the  use  of  spirits  afterwards  is  very  largely 
symptomatic,  indicating  exhaustion  and  deranged  condi- 
tions from  this  infection. 

Inebriety  dating  from  heat  and  sun-strokes  appears  in 
a  certain  number  of  cases.  In  former  times,  when  per- 
sons were  found  unconscious  on  the  streets  suffering  from 
heat  or  sun-strokes,  spirits  were  given  as  a  tonic,  and  the 
delirium  which  followed  was  exceedingly  difficult  and  com- 
plex to  determine. 

How  much  of  it  was  due  to  alcohol  or  to  the  profound 
changes  in  the  brain  circulation  from  the  heat  rays  could 
never  be  determined.  In  much  the  same  way  any  state 
of  unconsciousness  may  be  intensified  and  increased  by 
the  use  of  alcohol  to  an  extent  not  realized. 

A  prominent  example  was  of  two  men  walking  on  the 
street,  both  became  unconscious  from  the  intense  heat  of 
the  sun's  rays.  Both  were  taken  to  the  hospital.  One 


INEBRIETY. 


was  given  quantities  of  brandy  to  sustain  the  heart.  The 
other  received  no  treatment  other  than  cold  water.  The 
first  was  delirious,  and  after  a  long  serious  convalescence 
recovered.  He  continued  the  use  of  alcohol  the  rest  of 
his  lifetime. 

The  second  one  recovered  and  was  temperate.  The 
inference  is  that  the  effect  of  alcohol  increased  the  in- 
jury and  fixed  a  distinct  propensity  for  spirits  which  fol- 
lowed him  the  rest  of  his  life.  The  other  escaped.  This 
is  confirmed  by  the  study  of  other  cases,  one  of  which 
is  the  following  : 

Two  firemen,  both  abstainers,  were  struck  on  the  head 
by  a  piece  of  falling  timber.  One  became  an  inebriate 
soon  after,  using  alcohol  as  a  medicine  at  first  and  then 
to  great  excess  at  every  opportunity.  The  other  was  an 
invalid  for  the  rest  of  his  life,  but  did  not  drink. 

Blows  on  the  head,  either  from  falls,  direct  or  indirect 
injuries,  very  often  result  in  extreme  psychic  exhaustion 
and  crave  for  spirits.  Sometimes  this  is  seen  very  soon 
after  the  injury.  In  others  it  appears  at  a  later  period. 
It  is  considered  dangerous  at  present  to  use  spirits  in 
cases  of  this  kind,  for  the  reason  that  they  are  often 
hypersensitive  and  show  the  toxic  effects  from  a  very 
small  dose. 

In  others  little  more  than  heart  stimulation  follows, 
but  with  it  more  intense  nutrient  disturbance,  which  after 
a  while  develops  the  same  spirit  thirst.  There  is  a  wide 
field  of  psychic  injuries  and  shocks  to  the  brain  which 
end  in  inebriety,  that  have  not  been  studied.  Instances 
like  the  following  are  not  unusual  : 

Three  men,  all  abstainers,  in  middle  life,  vrere  pro- 
foundly shocked  by  the  sudden  fear  of  death  while  on  a 
train  which  jumped  the  tracks  and  ran  over  the  ties  for 
some  distance.  The  windows  were  broken,  the  lights  went 


INJURIES  AND  PSYCHOSES.  135 

out  and  the  passengers  were  thrown  about,  and  there 
was  much  confusion,  although  no  one  was  seriously  hurt. 

One  of  these  men  was  paralyzed  from  fear  and  had 
to  be  carried  out  of  the  car.  The  other  two  walked  with 
great  difficulty,  and  after  taking  their  friend  to  a  hotel, 
all  drank  spirits.  Two  became  stupid  at  once  from  a 
single  glass  of  spirits,  and  both  of  these  men  continued 
to  use  spirits  the  rest  of  their  lifetime.  The  third  one  is 
now,  years  after,  an  invalid  and  drugtaker  from  the 
exhaustion  following  this  shock.  Here  the  fear  broke  up 
the  brain  equilibrium  and  the  use  of  spirits  provoked  a 
distinct  drink  neurosis. 

Other  examples  are  those  of  persons  who  are  shocked 
by  electricity  or  a  stroke  of  lightning,  prostrated  and 
made  unconscious,  recovering  afterwards  and  complain- 
ing of  excessive  prostration  and  debility.  Later  they 
begin  to  drink  spirits,  become  intoxicated,  and  from  that 
time  on  they  are  powerless  to  restrain  themselves  and 
abstain.  Several  very  marked  cases  of  dipsomania  have  a 
history  of  similar  causes. 

It  is  also  noted  that  persons  working  with  electrical 
appliances  and  in  electrical  business,  who  receive  shocks 
frequently,  and  later  complain  of  profound  exhaustion, 
are  very  susceptible  to  the  use  of  alcohol  and  likely  to 
continue  its  use,  both  as  a  medicine  and  beverage. 

Another  class  of  causes  seems  to  precede  inebriety  with 
great  frequency,  such  as  direct  injuries  from  blows,  re- 
sulting in  broken  bones,  strains,  lacerated  wounds  with  a 
long,  slow  convalescence.  In  many  of  these  cases  there 
is  a  history  of  moderate  or  occasional  use  of  spirits  pre- 
ceding the  injury. 

In  others  the  persons  are  perfectly  temperate,  and 
have  never  used  alcohol  before  the  injury,  and  after  the 
injury  they  are  possessed  with  a  morbid  impulse  for  its 


136  INEBRIETY. 

use  on  all  occasions.  Undoubtedly  all  injuries  that  pro- 
foundly affect  the  nervous  system  are  more  dangerous  to 
one  accustomed  to  the  use  of  spirits  in  moderation  or  at 
long  intervals. 

In  such  persons  there  are  physically  greater  feebleness 
of  reparative  power,  and  greater  resistance  to  means  of 
restoration.  Psychically,  there  is  an  impression  of  the 
possible  relief  which  comes  from  the  use  of  alcohol,  based 
on  experience,  and  this  greatly  increases  the  difficulty  of 
recovery.  Thus  a  moderate  or  excessive  user  of  spirits, 
when  exhausted  or  depressed,  turns  to  alcohol  for  relief 
with  a  confidence  based  on  experience  which  is  very  mis- 
leading. 

When  a  person  who  has  no  experimental  knowledge  of 
the  effects  of  spirits  suddenly  becomes  possessed  with  the 
idea  of  their  great  value,  there  must  be  some  defect  or 
change  in  the  brain  to  account  for  it.  This  impression 
may  be  formed  from  observation  on  others,  or  suggestion, 
and  when  it  occurs  in  persons  who  have  previously  ex- 
pressed great  disgust  and  aversion  for  spirits  it  is  sig- 
nificant. 

Some  form  of  injury  is  undoubtedly  the  exciting  cause, 
provoking  a  new  condition  of  functional  activity  or  de- 
veloping some  old  inherited  predisposition.  Thus,  a 
total  abstainer  and  previously  temperate  man,  who  sud- 
denly begins  to  use  spirits,  with  a  history  of  injury  or 
some  form  of  shock  preceding  it,  is  suffering  from  a 
distinct  neurosis ;  whether  the  connection  can  be  traced 
or  not,  it  exists. 

Where  profound  exhaustion  follows  from  injury  the 
most  natural  suggestion  would  be  some  means  or  stimu- 
lants to  overcome  this  condition.  It  has  not  been  recog- 
nized to  any  great  extent  that  the  toxic  action  of  spirits 
used  for  this  condition  is  far  more  severe  than  at  any 
other  time. 


INJURIES  AND  PSYCHOSES.  137 

When  the  person  is  exhausted  the  increased  narcotic 
action  is  very  prominent.  In  surgical  operations  on  in- 
toxicated persons,  anesthesia  can  be  dispensed  with  in 
many  cases.  Many  of  the  older  surgeons  considered 
alcohol  of  equal  anesthetic  value  to  chloroform,  and  opera- 
tions were  performed  long  ago  with  no  other  narcotic 
than  spirits. 

Careful  study  shows  that  while  the  effect  of  alcohol 
inhibits  the  sensory  centers,  there  is  an  increased  de- 
pression following,  noted  in  the  greater  mortality.  Hence 
alcohol  is  not  considered  a  safe  narcotic.  It  has  also  been 
noted  that  in  many  of  the  modern  surgical  operations 
where  spirits  were  given  for  various  causes  there  has  been 
slow  repair  of  the  wounds,  and  not  unfrequently  alcohol 
has  been  used  afterwards  up  to  the  point  of  inebriety. 

Practical  men  of  large  observation  realize  that  alcohol 
in  any  form,  given  for  any  purpose  to  persons  who  are 
injured,  is  dangerous;  not  only  in  lengthening  out  the 
convalescence,  but  in  producing  an  addiction  afterwards. 

Many  cases  have  been  reported  of  alcohol  being  used 
as  a  medicine  at  first  and  finally  becoming  an  addiction, 
following  a  surgical  operation.  Evidently  there  is  some 
connection  between  the  effect  of  the  operation  and  the 
drinking  which  followed. 

Beer  drinkers  are  particularly  noted  for  their  impulsive 
use  of  strong  spirits,  following  any  shock  or  peculiar 
stress  or  strain  to  the  body.  This  is  evidently  due  to  the 
ana?mia  and  toxaemic  conditions  following  the  use  of  beer, 
furnishing  a  very  fertile  soil  for  the  craving  of  strong 
spirits ;  and  to  greater  susceptibilitv  to  pain,  and  in- 
ability to  disregard  the  discomfort  and  pain  incident  to 
this  condition. 

We  have  noted  elsewhere  the  frequency  of  the  history 
of  concussions,  shocks  and  general  disturbance  of  the 
system  preceding  the  use  of  spirits,  making  it  evident 


138  INEBRIETY. 

that  there  are  cumulative  effects  of  injuries  and  poisons, 
preparing  the  way  for  this  condition. 

It  is  also  clear  that  every  attack  of  intoxication,  or 
acute  poisoning  from  spirits,  increases  the  susceptibility, 
and  leaves  a  marked  psychosis,  from  which  recovery  is 
more  difficult. 

Some  very  interesting  examples  have  been  published  of 
moderate  or  excessive  users  of  spirits,  who,  from  injury 
or  disease,  have  suddenly  developed  an  intense  disgust  and 
repugnance  to  the  taste  and  smell  of  spirits,  and  have 
been  total  abstainers  the  remainder  of  their  lives. 

The  drink  craze  and  symptoms  seem  to  have  died  out 
at  once.  In  one  instance  a  moderate  drinking  man,  after 
becoming  unconscious  from  sun-stroke,  suffered  intense 
nausea,  and  vomited  at  both  the  sight  and  smell  of  spirits. 

In  another  instance  a  man  intoxicated  was  thrown  out 
of  a  wagon  and  badly  injured.  He  became  delirious,  was 
given  spirits.  The  delirium  was  increased,  and  with  it 
came  the  delusion  that  the  spirits  had  been  poisoned.  He 
recovered,  but  had  a  profound  impression  that  spirits  were 
poisonous,  and  exhibited  the  utmost  horror  and  excite- 
ment when  invited  to  drink. 

This  aversion  continued  until  his  death.  It  frequently 
happens  that  persons  recovering  from  severe  attacks  of 
alcoholic  delirium  or  delirium  tremens,  manifest  disgust 
and  repugnance  for  spirits  for  a  long  time,  but  this 
wears  away  in  most  instances. 

Empirics  attempt  to  take  advantage  of  this  fact  by 
increasing  the  disgust  and  nausea  from  the  effects  of 
spirits  to  secure  an  aversion  and  mental  effect.  In  this 
they  are  sometimes  successful.  The  aversion  to  alcohol, 
from  injury  or  disease,  is  a  pathological  condition  with  a 
tremendous  mental  effect  that  is  yet  to  be  studied. 

Many  cases  appear  where  acute  gastritis  is  followed  by 
an  intense  desire  for  spirits  and  their  effects.  Catarrhal 


INJURIES  AND  PSYCHOSES.  189 

and  bronchial  troubles  are  frequently  followed  by  the 
same  conditions.  Diseases  of  the  upper  air  passages 
which  are  treated  surgically  very  quickly  develop  spirit 
thirst. 

Railroad  men  in  the  transportation  service,  after 
years  of  sobriety,  suddenly  use  alcohol  to  great  excess. 
The  explanation  would  be  that  the  train  service  has  pro- 
duced a  constant,  steady  succession  of  physical  and 
psychical  shocks  and  strains,  and  this  has  brought  on 
exhaustion,  derangement,  and  the  use  of  alcohol. 

The  late  Dr.  Wright  reported  many  cases  of  serious 
exhaustion  and  diseases  which  profoundly  affected  the 
organism  in  early  life,  and  later  in  middle  life  inebriety 
appeared  without  any  special  exciting  causes.  In  these 
instances  there  seemed  to  be  an  intense  susceptibility  to 
the  narcotism  of  alcohol  which  evidently  had  its  basis  in 
early  injuries. 

Dr.  Parish  noted  in  the  history  of  many  cases  two 
distinct  conditions  following  traumata,  both  physical 
and  psychical.  One,  mental  degeneration,  shown  in  in- 
ebriety, drug-taking  and  various  forms  of  psychosis ;  the 
other,  a  change  in  the  habits,  mentality  and  conduct  of 
the  patient. 

The  influences  following  injury  are  always  very  potent 
and  to  be  considered  in  all  studies  of  inebriety.  While 
not  possible  to  point  out  the  distinct  connections  and 
causes,  it  is  always  wise  to  recognize  them  in  the  diagnosis 
and  treatment. 


CHAPTER  XIV. 

HEREDITY  AND  ITS  INFLUENCE  IN  THE  CAUSATION 
OF  INEBRIETY. 

Synopsis. —  Inherited  alcoholic  defects  a  fact.  Developing  dif- 
ferent conditions.  Certain  number  of  children  apparently  seem 
to  be  immune  from  the  effects  of  spirits,  yet  many  of  these  from 
special  exciting  causes  develop  the  taste  for  drink.  A  psycholog- 
ical susceptibility  may  be  inherited  and  remain  latent.  The  fact 
of  inheritance  of  inebriety  was  mentioned  in  an  early  age  of  the 
world.  Examples.  Two  forms  of  heredity.  Direct  and  indirect. 
Descriptions  of  cases  which  illustrate  these  forms.  Wealthy  and 
very  poor.  Both  furnish  examples.  Retarded  development. 
Feeble  vitality.  Great  irritability,  and  mental  instability  are 
symptoms.  Instances  illustrating  the  facts. 

Notwithstanding  the  doubts  and  denials  of  the  influ- 
ence of  heredity  in  inebriety,  clinical  evidence  shows  that 
intemperate  parents  are  almost  absolutely  certain  to  be 
followed  by  descendants  who  have  a  predisposition  and 
are  far  more  likely  to  become  inebriates  than  others. 

This  does  not  prove  that  all  descendants  of  inebriates 
will  use  alcohol,  but  that  in  certain  circumstances  they 
are  more  liable  to  find  relief  in  spirits,  and  continue  their 
use  ever  afterwards.  While  it  is  true  that  a  certain  num- 
ber of  children  of  drinking  parents  seem  to  possess  a 
profound  disgust  for  both  the  taste  and  smell  of  spirits, 
experience  shows  that  this  is  often  overcome,  and  whether 
they  are  more  susceptible  to  change  in  this  respect  is 
not  clear. 

This  aversion  for  drink  and  its  effects  takes  on  many 
different  forms  and  phases.  In  one  instance  nausea  and 
excitement  follow  the  sight  of  a  drinking  man,  or  the 
odor  of  spirits.  In  another,  indignation,  anger  and  desire 
to  force  the  drinking  man  out  of  his  condition.  Many  of 
the  most  intolerant  and  extreme  dogmatic  reformers  and 
critics  of  inebriates  come  from  alcoholic  ancestry. 
140 


HEREDITY  AND  ITS  INFLUENCE.  141 

To  many  men  there  is  great  confusion  in  the  effort  to 
explain  the  repulsion  for  spirits  and  drinkers.  In  some 
there  is  great  toleration,  up  to  the  verge  of  fascination; 
in  others,  there  are  wide  variations  in  the  effects  of  al- 
cohol; in  the  children  of  drinking  parents  there  are  dis- 
tinct degrees  of  susceptibility  and  immunity  that  often 
follow  uniform  lines  of  progress. 

In  certain  cases  there  is  a  peculiar  physiological  sus- 
ceptibility, which  may  be  developed  or  remain  latent  until 
brought  into  activity  by  special  causes.  There  is  a 
great  deal  of  historic  evidence,  showing  the  hereditary 
impulses  to  alcohol.  In  the  early  ages  of  the  world  the 
drunkenness  of  children  of  drinking  parents  was  ascribed 
to  inheritance  by  a  great  variety  of  philosophers,  physi- 
cians and  writers. 

Vulcan's  lameness  was  said  to  be  the  direct  result  of 
Jupiter's  intoxication.  Diogenes  declared  that  stupidity 
in  children  was  the  direct  result  of  the  drunkenness  of 
the  parents.  Aristotle  presented  a  great  variety  of  evi- 
dence, showing  that  drinking  women  always  bore  children 
who  were  feeble  and  drank.  The  legislation  of  Lycurgus 
urged  that  drunkenness  should  be  promoted  and  encour- 
aged in  vanquished  nations,  so  that  their  patriotism  could 
be  extinguished  and  longevity  lessened,  and  in  this  way 
their  race  would  become  degenerate.  The  Greek  litera- 
ture is  full  of  references  to  the  direct  result  of  wine  drink- 
ing as  sources  of  degeneration,  damage  and  destruction 
to  the  offspring. 

These  statements  were  based  on  observation  and  were 
not  theories,  but  were  confirmed  by  experience  of  that 
and  later  times.  There  appear  to  be  two  forms  of 
heredity  ir.ore  marked  than  others  in  the  children  of 
alcoholics. 

The  first  may  be  called  direct  heredity,  in  which  the 
same  form  of  drinking  appears  in  the  next  generation. 


142  INEBRIETY. 

The  conduct  and  acts  of  children  are  practically  the 
same  as  their  parents.  The  same  diseases  occur  and  the 
same  manner  and  method  of  using  spirits  follow. 

The  second  is  called  indirect  heredity,  in  which  alco- 
holic defects  of  the  parents  appear  in  various  widely 
differing  brain  and  nerve  disorders.  The  following  table 
gives  in  an  outline  way  the  conditions  which  are  very 
commonly  seen  in  the  descendants  of  inebriates : 


Heredity 


T»    j.         ...  i  Special 

1 rcdisposition    <  _ 

(  General 


Defects 


Physiological. 
Psychological. 


Physical  Weakness. 
Retarded   Development.  \  , ,     ,   ,  „,    , 

f  Mental  Weakness. 


It  is  a  general  observation,  noted  in  every  study,  that 
where  one  or  both  parents  use  spirits  to  excess,  the  off- 
spring show  marked  predisposition  to  exhaustion  and 
degeneration,  and  give  evidence  of  general  defective  and 
retarded  growth. 

Often  this  predisposition  occurs  in  one  of  two  forms 
called  general  or  special.  In  the  first  the  children  will 
be  weakly,  have  feeble  power  of  endurance  of  pain  and 
discomfort  and  seek  relief  from  any  source.  Spirits  pre- 
scribed, either  openly  or  concealed,  seem  very  grateful 
in  the  rapid  relief  of  the  conditions  present. 

Thus  irritable,  peevish  children  from  drinking  parents 
are  easily  quieted  by  medicines  of  this  character.  Hence 
patent  drugs  or  any  substance  containing  spirits,  are 
popular  remedies  in  such  families.  Thoughtful  parents 
often  notice  this  fascination  for  the  effects  of  medicine 
containing  alcohol,  and  make  strenuous  efforts  to  teach 
the  horrors  of  its  use. 


HEREDITY  AND  ITS  INFLUENCE.  143 

Children  brought  up  and  trained  to  abhor  alcohol, 
not  unfrequently  discover,  in  early  manhood  or  woman- 
hood, drugs  containing  spirits,  which  have  a  pronounced 
soothing  effect,  and  from  this  they  sooner  or  later  be- 
come addicted  to  its  use. 

The  following  is  an  example:  John  Smith  was  an 
inebriate,  although  the  fact  was  concealed  from  his  fam- 
ily. His  wife  was  a  strong  temperate  woman,  and  each 
of  the  five  children  born  to  her  were  feeble  in  early  life, 
and  suffered  severely  from  children's  diseases. 

They  all  manifested  an  intense  satisfaction  from  any 
form  of  alcohol  given  as  a  medicine.  The  mother  rec- 
ognized this  inherited  taste,  and  sought  every  means  to 
overcome  it.  Two  of  the  boys  drank  during  their  col- 
lege life,  but  later  became  devoted  temperance  men  and 
strong  total  abstainers.  The  third,  a  girl,  became  a 
drug-taker,  after  the  disappointment  of  an  unfortunate 
marriage. 

The  fourth  was  an  erratic,  feeble-minded  child,  that 
died  early.  The  fifth  was  an  erratic  preacher,  whose 
eccentricities  were  the  subject  of  much  comment.  He 
finally  died  a  concealed  inebriate.  This  example  is  quite 
a  common  one,  and  can  be  duplicated  from  the  experi- 
ence of  nearly  every  medical  man. 

It  often  happens  that  most  unexpected  results  fol- 
low the  use  of  medicines  containing  spirits.  In  one  in- 
stance the  effects  are  very  obscure.  In  another,  prac- 
tically the  same  case,  they  are  very  pronounced,  and  the 
quieting  action  from  it  is  marked.  Unreasoning  physi- 
cians ascribe  this  to  different  causes,  but  in  many  in- 
stances it  is  found  to  depend  entirely  upon  the  alcohol 
and  the  latent  heredity  of  the  patient. 

Many  persons  are  aware  of  the  effect  of  a  small  quan- 
tity of  spirits  given  either  concealed  or  openly.  The 
pleasing  results  following  it  show  a  special  predisposi- 


INEBRIETY. 


tion  which,  if  cultivated,  would  make  them  inebriates  in 
a  very  short  time.  Such  persons  with  ordinary  caution 
assert  that  they  cannot  take  spirits,  the  real  reason  being 
that  its  effects  are  so  pleasing  that  it  would  lead  up 
to  very  serious  results. 

In  others  this  predisposition  is  not  recognized,  and  the 
remedy  is  sought  for  and  continued  until  finally  it  dawns 
on  them  that  it  is  the  alcohol  in  it  that  is  most  agreeable. 
Then  they  begin  using  it  directly.  This  predisposition 
to  use  alcohol  for  its  grateful  effects  seems  to  follow 
some  general  law  which  some  authors  have  studied. 

Thus,  if  the  father  is  a  drinking  man,  using  spirits 
to  excess,  the  daughter  will  inherit  this  predisposition 
more  prominently  than  the  son,  and  while  the  daughter 
may  not  use  spirits,  there  will  be  apparent  some  partic- 
ular neurosis  and  psychosis  due  to  alcoholic  defects  in 
parents. 

If  the  mother  drinks,  the  predisposition  breaks  out  in 
the  son,  in  more  decided  form  than  in  the  daughter,  and 
with  little  or  no  exciting  cause.  In  the  study  of  a  large 
number  of  persons,  the  inebriety  of  the  grandfather  on 
the  mother's  side,  appears  very  often  in  the  boys.  The 
mother  may  have  been  a  total  abstainer,  but  failed  to 
live  hygienically,  hence  the  son  manifests  both  the  grand- 
father's weakness  and  his  mother's  defects. 

Women  of  the  wealthy  classes  who  use  wine  on  the 
table  are  very  often  followed  by  boys  who  drink  to  great 
excess,  while  the  daughters  remain  practically  temper- 
ate. Where  both  parents  drink,  this  special  heredity  is  in 
tensified  in  complex  forms  of  neurosis  and  psychosis,  in 
which  some  of  the  children  will  show  immunity  and 
deterring  horror  of  the  use  of  spirits,  and  be  strictly 
temperate,  and  others  will  be  fascinated  by  the  effects 
of  spirits,  and  have  no  power  to  refrain  from  its  ex- 
cessive use. 


HEREDITY  AND  ITS  INFLUENCE.  145 

In  both  there  is  always  present  what  may  be  termed 
a  general  diathesis,  or  tendency  to  exhaustion,  with  ina- 
bility to  bear  discomfort  and  constant  efforts  to  seek 
relief.  Tuberculosis  is  a  very  marked  form  of  defect 
following  in  the  children  of  alcoholic  ancestors.  The 
same  low  vitality  and  feeble  resisting  power,  which  pro- 
voke the  use  of  spirits,  manifest  themselves  in  the  early 
breaking  down  of  the  lungs  from  acute  inflammatory 
trouble  or  bacterial  invasion,  and  this  is  overcome  with 
great  difficulty. 

It  is  stated  as  a  rule,  observed  by  many  authors,  that 
the  descendants  of  alcoholic  ancestors  usually  die  of 
tuberculosis  or  pneumonia.  Of  course,  acute  disorders 
of  nutrition  and  inflammations  of  the  kidneys  and  other 
organs  are  also  prominent. 

It  is  along  the  line  of  other  observation  that  these 
children  show  feebleness,  general  defects  and  entailments 
from  the  parents,  which  manifest  themselves  in  the  con- 
stant desire  for  relief  and  help.  There  is  a  great  wealth 
of  clinical  facts  to  be  studied  in  this  direction,  and  the 
terms  general  and  special  heredity  give  some  idea  of  the 
outline  forms  of  the  laws  that  govern  these  conditions. 

Why  aversion  and  immunity,  fascination  and  predis- 
position to  spirits  and  its  effects  should  exist  in  one  fam- 
ily ;  and  in  another  extreme  exhaustion,  neurosis  with 
nutritive  and  organic  feebleness ;  and  in  a  third  circu- 
latory diseases,  or  brain  weakness,  extending  all  the  way 
from  genius  to  idiocy ;  must  be  answered  by  further 
studies. 

The  physical  and  mental  defects  seen  in  children  of 
inebriates  are  unmistakable  signs  of  the  decline  of  race 
stock  and  vigor,  even  to  extinction  and  death.  This 
is  noted  in  the  faulty,  imperfect  development  of  heads 
and  bodies  of  such  children,  together  with  other  ab- 
normalties,  both  physiological  and  psychological. 


146  INEBRIETY. 

The  instability  of  mental  activities  and  functional 
control  is  also  marked.  In  the  examinations  for  the  army 
and  navy,  and  in  life  insurance  work,  these  abnormali- 
ties are  very  prominent,  and  are  studied  by  insurance 
men  to  determine  their  relations  to  longevity.  One  au- 
thor believes  that  the  inherited  degenerations  from  alco- 
hol are  noted  in  the  eyes,  which  are  defective,  and  re- 
quire glasses  in  early  life ;  stigmatic  heads  and  faces, 
ears,  arms  and  legs  are  marked  defects.  Psychologically, 
this  is  seen  in  the  credulity,  skepticism,  impulsiveness, 
selfishness  and  ungoverned  instincts ;  also  in  the  erotic, 
paranoic  men  and  women,  whose  extreme  defects  of  judg- 
ment, reason  and  conduct  are  traceable  to  alcoholic 
ancestry. 

An  army  of  such  people  live  on  the  border  lines,  where 
sanity  and  insanity  unite,  and  they  furnish  at  least 
twenty  per  cent,  of  all  the  insane  or  persons  pro- 
nouncedly diseased  mentally.  In  this  same  class  can 
often  be  traced  geniuses,  reformers,  and  sometimes  great 
pioneers  in  the  world's  work.  Many  of  them  are  ab- 
stainers. Others  are  periodics  and  impulsive  users  of 
spirits. 

Elsewhere  more  extended  reference  is  made  to  these 
classes.  As  examples  of  retarded  development,  due  to 
heredity,  the  following  may  be  presented: 

John  Doe,  a  highly-trained  lawyer,  whose  father  was 
a  moderate  drinker,  and  mother  a  neurotic  society  woman, 
suffered  from  early  life  from  extreme  physical  exhaus- 
tion, particularly  from  any  overwork  or  strain.  He 
would  work  for  days  with  the  greatest  intensity,  and 
then  have  periods  of  depression  in  which  he  claimed  to 
be  sick. 

He  passed  through  college  and  the  university,  work- 
ing in  this  irregular,  convulsive  way,  and  as  a  lawyer 
attained  reputation  for  the  great  and  spasmodic  inten- 


HEREDITY  AND  ITS  INFLUENCE.  147 

sity  of  his  mental  activity.  He  was  a  total  abstainer, 
had  a  horror  of  spirits,  but  in  middle  life  began  to  use 
drugs  for  exhaustion,  and  then  spirits.  He  died  an 
inebriate. 

James  Brown,  from  a  similar  ancestry,  exhibited  great 
weakness  at  times,  and  while  a  man  of  ordinary  judgment, 
was  very  easily  distressed  and  disturbed  by  the  small- 
est events  in  life.  When  excited  he  was  almost  an 
imbecile  in  his  conduct  and  talk,  and  after  a  rest  would 
fully  recover. 

He  remained  temperate  all  his  life,  but  was  feeble- 
minded and  melancholic  during  the  last  years.  Both 
of  these  cases  had  stigmata  in  face  and  ears,  and  were 
abnormally  developed  in  many  ways.  Instances  will 
occur  to  the  reader  of  persons  abnormal  in  appearance, 
whose  ancestors  have  been  moderate  or  excessive  users 
of  spirits,  and  whose  lives  and  conduct  have  been  irregu- 
lar and  unusual. 

Criminals  furnish  marked  examples  of  this  class,  and 
drug-takers  are  very  common.  The  recurrence  of  sim- 
ilar conduct  and  acts  at  certain  periods  of  life  in  sev- 
eral generations  point  to  laws  of  heredity  that  have  not 
been  studied  very  well. 

Thus,  in  one  instance,  the  male  members  of  the  family 
for  three  generations  all  drank  spirits  to  excess  between 
forty-five  and  fifty  years  of  age.  Many  of  them  were 
total  abstainers  up  to  that  time.  Others  had  been  mod- 
erate drinkers.  Their  previous  life  gave  no  indications 
of  this  outbreak  which,  in  most  cases,  came  on  suddenly. 
In  this  particular  family,  two  persons,  both  exem- 
plary clergymen  and  active  reformers,  began  to  use 
spirits  at  this  critical  age,  and  died  in  insane  asylums. 

In  the  next  generation,  both  a  man  and  woman,  one 
forty-eight  and  the  other  fifty-one,  began  to  use  spirits 
suddenly,  and  died  within  a  couple  of  years.  In  the 


148  INEBRIETY. 

third  generation,  three  women  and  one  man  all  drank 
and  took  drugs  at  this  time.  Two  lived  many  years. 
The  others  died  early. 

In  another  family,  the  grandfather,  father  and  two 
sons  of  three  generations  were  all  strictly  abstinent  up  to 
thirty-five  years  of  age ;  then  all  began  to  use  spirits  for 
various  superficial  reasons,  and  all  died  soon  after. 

In  another  instance,  a  man  of  fifty  years  of  age,  a 
successful,  temperate  business  man,  began  to  drink  to 
great  excess  for  no  other  reason  than  that  he  could  not 
help  it.  It  was  ascertained,  although  the  patient  did  not 
know  it,  that  his  father  had  been  a  total  abstainer  up 
to  that  age.  Then,  after  an  alcoholic  excess  for  a  period 
of  a  few  months,  he  became  insane. 


CHAPTER  XY. 

SOME  OF  THE  NEUROSES  FOLLOWING  INE- 
BRIETY IN  PARENTS. 

Snyopsis. — The  periodicity  of  the  drink  impulse.  Very  signifi- 
cant symptoms.  Its  possibilities  in  other  neuroses.  Difficult  to 
explain  it.  Its  appearance  at  certain  stages  of  life  and  resem- 
blance to  epilepsy.  Dipsomania  a  particular  phase  of  degeneration 
not  common.  Always  dependent  on  hereditary  defects.  Genius 
associated  with  it.  Declining  families.  Efforts  of  nature  to  check 
extinction.  Borderline  palsies.  People  who  live  on  the  border- 
lands of  insanity.  Their  strange  conduct  and  acts.  The  effects 
of  marriage  in  changing  the  race  march.  Illustrated  cases.  The 
Chinese  law  on  heredity.  A  recognition  of  the  uncertainty  of  in- 
heritance. Opinion  of  Morell.  Opinions  of  Maudsley.  Lunier's 
studies.  Other  studies  of  heredity.  Influence  of  education,  train- 
ing and  marriage.  Possibilities  of  checking  the  transmission  of 
defects.  Folly  of  theories.  Appeal  to  facts.  Illustrations. 

The  periodicity  or  recurrence  of  the  drink  impulse  in 
early  life  points  clearly  to  some  inherited  defect  which 
gathers  and  explodes  after  a  fixed  cycle  of  years. 

It  is  very  difficult  to  explain  the  conditions  which 
provoke  this  desire  and  make  it  ungovernable  at  this 
time.  It  is  possible  that  it  may  have  existed  before,  but 
has  been  controlled  and  overcome,  until  finally  it  broke 
all  barriers  and  developed. 

Illustrations  of  the  duration  and  limitation  of  the 
vital  forces  to  certain  distinct  periods  are  seen  in  certain 
families  where  death  occurs  about  the  same  time  of  life. 
Often  the  causes  of  death  are  similar,  and  break  out 
with  or  without  any  particular  exciting  causes. 

Many  instances  are  noted  in  which  diseases  of  nutri- 
tion appear  at  a  certain  fixed  time  of  life  in  several  gen- 
erations. The  excessive  use  of  alcohol,  terminating 
fatally,  has  been  noted  in  many  such  cases.  The  same  fact 
has  been  noted  in  families  in  which  respiratory  diseases 

appeared  after  thirty,  principally  pneumonia  and  tuber- 

149 


150  INEBRIETY. 

culosis.  Instead  of  these  family  diseases,  inebriety  would 
apparently  take  their  place,  only  it  would  progress  with 
great  intensity  to  a  more  rapid  termination. 

Epilepsy  is  another  form  of  convulsive  degeneration 
that  frequently  precedes  and  follows  the  use  of  alcohol. 
This  is  a  direct  result  from  alcoholic  ancestors.  In  a 
number  of  cases  there  was  distinct  evidence  that  chil- 
dren of  alcoholic  parents,  who  drank  freely,  developed 
delirium  more  quickly  than  others  without  this  heredity. 

The  term  dipsomania  describes  a  particular  form  of 
mania  for  the  use  of  spirits,  which,  in  intensity,  exceeds 
all  other  impulses.  This  is  frequently  seen  as  a  heredi- 
tary entailment.  Where  the  degenerative  effects  of  the 
continuous  use  of  spirits  manifest  themselves  in  convul- 
sions, which  are  called  epileptoid,  the  same  heredity  will 
be  found  in  most  instances. 

Children  of  inebriates  often  exhibit  a  special  neurotic 
temperament  in  irritability,  hypersensitiveness  and  un- 
usual prostration  from  any  particular  exertion.  Not  in- 
frequently such  children  exhibit  precosity  and  unusual 
mental  development,  which,  after  a  time,  declines  and 
leaves  physical  and  mental  feebleness. 

The  fact  is  established  beyond  all  question  that  alco- 
holic parents  cannot  transmit  normal  vigor  and  health 
to  their  children. 

All  such  descendants  exhibit  feebleness  in  resisting  dis- 
ease, less  strength,  lower  vitality  and  greater  difficulty 
in  adapting  themselves  to  the  exacting  conditions  of  life. 
In  epidemics  and  infectious  diseases  such  children  have 
greater  mortality. 

It  is  also  noted  that  families  with  this  heritage  are  on 
the  road  to  extinction,  and  that  nature  wisely  hurries 
on  these  defectives  to  death.  Extinction  can  only  be 
prevented  by  union  with  a  healthier  race,  in  which  the 
tendency  is  checked. 


NEUROSES  FOLLOWING  INEBRIETY  IN  PARENTS.  151 

Often  a  great  effort  is  made  to  stop  this  downward 
tendency  by  remarkable  fecundity.  Thus,  in  degenerate 
families,  a  large  number  of  children  are  born,  exhibiting 
all  the  defects  of  the  parents,  and  usually  dying  early. 
This  is  considered  a  hint  that  nature  is  making  a  great 
effort  to  check  this  downward  career. 

It  not  unfrequently  happens  that  some  genius  appears 
among  these  descendants,  who  starts  far  above  the  level 
of  his  ancestors,  and  does  some  great  work,  as  an  in- 
ventor, reformer  or  orator.  Then,  after  a  short,  brilliant 
career,  disappears. 

He  is  the  last  member  of  a  family  that  has  been  on 
the  descending  path,  and,  like  the  flicker  of  a  lamp, 
bursts  into  full  blaze  before  extinction.  Where  this 
alcoholic  heredity  and  degeneration  is  retarded  or  accel- 
erated by  the  union  with  different  families  of  varied 
heredity,  very  strange  products  are  the  result. 

While  alcoholic  defects  may  not  appear  in  the  next 
generation,  various  grades  of  idiocy,  criminality,  pauper- 
ism, tramps,  and  the  most  complex  degenerations  of  mind 
and  body  are  traceable  in  the  children. 

Many  of  these  degenerative  descendants  show  defects 
of  consciousness  and  conception  of  duty,  for  which  the 
term  moral  paralysis  is  strikingly  descriptive.  Many  of 
them  live  on  the  very  borders  of  insanity,  and  their 
abnormalities  are  concealed  until  some  occasion  occurs 
in  which  they  break  out  with  great  distinctiveness. 

Others  seem  to  be  hopelessly  stranded  in  this  border 
region,  between  sanity  and  insanity,  and  their  conduct 
is  puzzling.  They  are  rated  as  great  geniuses,  orators, 
reformers,  and  strange,  erratic  people,  called  by  the 
modern  term  paranoics,  or  persons  with  a  mental  twist. 

Such  persons  are  always  enigmas,  and  their  thoughts 
and  conduct  are  never  along  normal,  rational  lines. 


INEBRIETY. 


One  great  fact,  not  often  recognized,  is  that  such 
descendants  have  a  lower  moral  sense  and  feebler  concep- 
tions of  right  and  wrong.  The  fact  mentioned  before 
is  sustained  by  a  great  variety  of  evidence,  that  the  use 
of  spirits  has  a  particular  paralyzing  action  on  what 
may  be  called  the  ethical  brain,  or  moral  consciousness 
of  right  and  wrong,  this  faculty  being  lowered  and 
paralyzed  in  different  degrees  in  all  persons  who  use 
spirits  to  excess. 

The  additional  fact,  confirmed  by  strong  evidence,  is 
that  children  of  these  alcoholic  ancestors  in  a  special 
degree  seem  to  inherit  this  particular  moral  defect,  and 
from  the  use  of  spirits  this  is  greatly  intensified  until 
a  decided  paralysis  of  the  highest  brain  centers  appear. 

Many  of  the  most  dangerous  criminals  and  persons, 
whose  lives  are  a  continuous  antagonism  to  law  and  order, 
duty  and  obligation,  are  children  of  alcoholic  ancestors. 

This  fact  is  illustrated,  when  persons  with  this  heredity 
occupy  places  of  prominence  in  public  opinion,  become 
possessors  of  wealth,  often  exhibiting  unusual  intelli- 
gence and  capacity,  and  then  suddenly  become  default- 
ers or  criminals  in  most  unexpected  ways. 

A  study  of  the  character  and  conduct  of  such  persons 
not  unfrequently  brings  out  depraved  motives  and  pur- 
poses, with  skillful  efforts  to  conceal  and  cover  up  their 
real  purposes.  Very  interesting  studies  along  this  line 
have  pointed  out  some  very  startling  theories  of  degen- 
eration that  are  practically  unknown  at  present. 

Another  fact  has  been  made  prominent  in  some  start- 
ling examples  where  children  from  alcoholic  ancestors 
are  given  the  highest  possible  culture  and  training  along 
unphysiological  lines  and  without  reference  to  their 
hereditary  defects.  The  results  have  been  great  abnor- 
malities, extraordinary  paranoics,  egotists,  with  extrava- 
gant exceptions  of  duties  and  relations  of  life,  with  a 


NEUROSES  FOLLOWING  INEBRIETY  IN  PARENTS.  153 

feeble  common  sense  and  strange,  unreasonable  creduli- 
ties. These  persons  are  called  by  many  authors  mental 
dyspeptics. 

Such  persons  are  seen  in  the  professions,  in  business 
circles  and  among  the  idle  classes,  and  their  erratic  con- 
duct and  inconsistencies  are  the  cause  of  continuous 
wonderment.  The  Chinese  law,  enacted  many  thousands 
of  years  ago,  forcibly  brings  out  some  of  the  great 
truths  of  heredity.  Thus,  when  a  criminal  came  before 
the  courts,  they  first  asked,  who  and  what  his  parents 
were.  If  they  were  found  to  have  had  any  of  the  traits, 
manners  or  habits  of  conduct  corresponding  to  the  crime 
of  the  prisoner,  he  was  killed  at  once,  and  they  were 
severely  punished. 

His  death  ended  all  possibility  of  any  transmitted 
defects  and  criminal  instincts,  and  their  punishment  was 
supposed  to  stop  all  further  propagation  of  the  evils. 
Parents  who  do  not  receognize  the  facts  of  heredity,  par- 
ticularly the  possible  damage  from  the  use  of  alcohol, 
that  may  be  transmitted,  are  committing  unpardonable 
sins  in  rearing  descendants  who  are  crippled,  and  must 
of  necessity  be  unable  to  attain  healthy  growth  and 
development. 

There  are  some  very  startling  laws  which  govern 
the  degenerations  of  the  race,  particularly  those  starting 
from  spirit-drinking  ancestors.  These  laws  are  often  inti- 
mately associated  with  other  forms  of  disease,  so  that 
it  is  difficult  in  the  present  state  of  study  to  indicate 
their  exact  place. 

Morell,  a  French  alienist,  has  given  the  following  table 
of  the  lines  of  degeneration,  which  he  has  observed  in 
his  study  of  inebriety  from  alcoholic  ancestors :  First 
generation,  alcoholic  excess  and  general  physical  de- 
pravity, with  immorality,  terminating  in  sudden  death 
from  acute  disease  or  violence. 


INEBRIETY. 


Second  generation,  a  craze  for  alcohol,  either  early  or 
late  in  life,  or  at  the  advent  of  some  crisis.  Spirit- 
drinking  is  often  maniacal,  both  in  its  use  and  the  re- 
sults following,  and  associated  with  nerve  and  brain 
debility,  disease,  paralysis,  and  a  great  variety  of  de- 
generations, ending  in  death. 

The  third  generation  is  marked  by  idiocy,  imbecility, 
delusional  homicidal  tendencies.  The  excessive  use  .  of 
spirits  is  followed  by  most  erratic  conduct.  Often  ex- 
treme horror  of  alcohol  and  great  remorse  are  followed 
by  sudden  death  and  extinction  of  the  race. 

Maudsley,  a  distinguished  alienist,  classifies  heredity 
in  three  distinct  forms  —  first,  the  appearance  of  the  same 
form  of  disease,  particularly  in  children  of  drinking  par- 
ents ;  second,  that  of  allied  forms  of  disease  ;  third,  into 
some  form  of  neurosis  and  psychosis,  in  which  the  an- 
cestorial  defect  is  the  evident  cause. 

He  asserts  that  the  parents  transmit  to  their  children 
not  only  the  family  traits,  but  the  individual  character 
and  degree  of  health,  and  while  these  may  be  modified  by 
losses,  sufferings,  errors,  achievements,  degradations  and 
degenerations,  they  follow  a  uniform  line,  which  is  trace- 
able in  most  cases. 

From  studies  covering  a  very  large  number  of  cases, 
the  following  general  lines  of  descent  seem  to  be  most 
prominent.  The  first  generation  from  alcoholic  ances- 
tors will  exhibit  low  vitality  from  infancy,  with  great 
feebleness  or  precosity  of  mental  activity,  associated  with 
defects  of  control.  Such  persons  may  often  be  total  ab- 
stainers of  a  very  pronounced  type,  or  moderate  and 
excessive  users  of  spirits.  They  appear  to  be  particu- 
larly prone  to  acute  diseases.  Convulsive  and  nutritive 
disturbances  appear  in  middle  life.  In  the  next  genera- 
tion, where  spirits  are  used,  very  marked  psychosis  and 
neurosis  become  prominent,  and  the  mortality  is  increased. 


NEUROSES  FOLLOWING  INEBRIETY  IN  PARENTS.     155 

In  the  third  generation,  criminality,  pauperism,  idiocy 
and  low  grades  of  insanity  end  in  extinction  of  the 
race. 

Often  the  race  ends  in  the  second  generation,  but 
where  marriage  is  contracted  with  vigorous  stocks,  the 
tendency  is  checked,  and  degeneration  may  be  neutral- 
ized. Where  marriage  is  contracted  with  equally  de- 
fective races,  the  alcoholic  psychosis  becomes  fixed,  and 
the  descendants  die  early,  and  are  largely  spirit  and  drug 
neurotics. 

The  only  hope  for  children  of  alcoholic  ancestors,  who 
wish  to  continue  the  line  of  descent  and  prevent  its 
extinction,  is  to  marry  into  strong  families.  Many  inter- 
esting studies  have  been  made  to  determine  how  far 
alcoholic  heredity  is  a  factor  in  mental  disease. 

Lunier,  in  a  study  of  many  thousand  cases  in  asylums 
for  idiots  and  the  insane,  in  France,  decided  that  over  50 
per  cent  of  all  cases  were  directly  traceable  to  alcoholic 
ancestors.  Legraine,  a  noted  specialist,  made  an  ex- 
haustive study  two  years  ago  in  France,  and  concluded 
that  60  per  cent,  of  all  mental  diseases  were  due  to  this 
cause.  The  late  Dr.  Wright  made  extensive  studies  of 
the  heredity  in  a  large  number  of  cases  in  this  country, 
and  decided  that  at  least  70  per  cent,  was  traceable  to 
alcoholic  degenerations  of  both  patients  and  parents. 

He  confirmed  Lunier's  statements  that  more  than  half 
of  the  mental  diseases  were  traceable  to  alcohol.  His 
studies  showed  the  following  line  of  descent:  Mental  in- 
stability, want  of  self-control,  hypersensitiveness  to  pain, 
low  vitality,  feeble  resisting  power,  constant  desire  for 
relief,  defective  nutrition,  irritability,  want  of  ambition, 
selfishness,  restlessness,  perversions  of  reason,  credulities 
and  egotism. 

In  the  next  generation,  stigmata  of  the  head,  face, 
ears,  eyes  and  teeth  appeared.  Irregularities  of  the  body 


156  INEBRIETY. 

and  external  indications  of  retarded  and  defective  devel- 
opments. With  this,  pauperism,  criminality,  insanity 
were  common  conditions,  and,  finally,  the  race  was  ex- 
tinguished. 

The  late  Dr.  Kerr  concluded,  from  a  large  number  of 
cases,  that  complex  forms  of  insanity,  as  well  as  ine- 
briety, were  almost  certain  to  appear  in  the  second  gen- 
eration of  inebriates.  He  claimed  that  insane  parents 
were  followed  by  inebriate  children,  and  inebriate  parents 
by  insane  children,  using  the  term  insanity  in  the  broad- 
est sense  as  describing  all  complex  forms  of  neuro- 
psychosis, and  general  defects  and  abnormalities  of  the 
brain. 

He  said,  "Any  transmitted  disease  which  increases  nerve 
susceptibility  and  exhausts  nerve  strength  and  power  of 
control,  will  positively  appear  in  some  form  of  defect 
and  degeneration  in  the  next  generation."  Inebriety  is 
one  of  these  diseases  which  will  develop  the  same  or  an 
allied  disease  in  a  large  proportion  of  cases. 

Dr.  L.  D.  Mason,  in  an  exhaustive  study  of  7,000  in- 
ebriates, concluded  that  fully  60  per  cent  had  alcoholic 
ancestors,  either  parents  or  grandparents.  In  a  later 
study,  he  found  that  50  per  cent,  of  all  mental  and  ner- 
vous diseases  were  referable  to  this  cause. 

The  late  Dr.  Day  found  that  in  5,000  cases  70  per 
cent,  were  traceable  to  alcoholic  ancestors.  The  late  Dr. 
Parish,  from  a  very  large  experience,  urged  that  at  least 
50  per  cent,  of  all  inebriates  were  hereditary  cases.  He 
claimed  that  70  per  cent,  of  all  idiots  came  from  this 
cause,  and  that  alcohol  was  either  an  active  or  predis- 
posing cause  in  nearly  all  the  degenerations  that  were 
marked  by  criminality,  pauperism  and  allied  defects. 

In  a  personal  study  of  over  4,000  cases,  over  60  per 
cent,  were  traceable  to  this  cause ;  20  per  cent,  were  prac- 
tically children  of  insane  persons,  or  persons  who  were 


NEUROSES  FOLLOWING  INEBRIETY  IN  PARENTS.     157 

mental  defectives,  as  well  as  inebriates.  The  parents  of 
the  others  were  more  markedly  inebriates,  but  presented  a 
great  variety  of  neuro-psychopathic  disturbances  and 
paranoic  tendencies. 

These  are  some  of  the  conclusions  reached  by  persons 
of  large  experience  and  ample  opportunities  for  study. 
A  very  interesting  question  has  been  the  subject  of  con- 
siderable literature,  namely,  how  far  education,  training 
or  marriage  prevents  or  neutralizes  the  inherited  defects 
and  tendencies  to  inebriety. 

The  answer  opens  a  very  wide  field,  with  possibilities 
that  are  startling.  It  is  very  evident  that  defective  edu- 
cation, bad  training,  as  well  as  unwise  marriages,  may 
intensify  and  develop  the  inheritance  and  destroy  every 
possible  hope  of  recovery  or  normal  life. 

In  some  studies,  recently  made,  the  question  is  asked 
in  what  direction  do  these  transmitted  defects  appear 
to  be  most  prominent?  The  answer  to  this  would  often 
suggest  methods  of  treatment  and  forms  of  training 
that  would  overcome  this  condition.  The  subject  is 
practically  a  great,  dark  continent,  awaiting  exploration, 
and  the  few  landmarks  pointed  out  by  many  observers 
only  show  how  much  there  is  yet  to  be  studied.  Prac- 
tical men,  working  in  institutions,  have  no  patience  with 
theorists  who  deny  the  transmission  of  inherited  defects. 
They  look  forward  with  eagerness  to  advanced  educa- 
tional studies  that  will  teach  how  to  overcome  and  neutral- 
ize these  tendencies,  and  to  parental  training  and  culture 
that  will  save  the  race  from  this  downward  march. 


CHAPTER  XVI. 

PSYCHIC  PHENOMENA  OF  INEBRIETY  TRACEABLE 
TO  HEREDITY. 

Synopsis. —  Prominent  defects  noted  in  asylums.  Traceable  to 
persons  in  whom  symptoms  of  intoxication  are  present.  To  a 
second  class  in  which  these  symptoms  only  appear  from  special 
exciting  causes.  In  the  first  class  the  intoxication  of  parents  is 
prominent.  Deformities  of  body  and  face  appear.  The  mind 
shows  similar  defects.  In  the  second  class  mental  symptoms  ap- 
pear when  the  person  is  excited.  These  symptoms  are  repetitions 
of  toxic  states  of  parents.  Illustrations.  Morbid  fears.  Imbecile 
conditions.  Persons  who  when  excited  show  symptoms  of  intox- 
ication. Parents  often  periodic  or  moderate  drinkers.  Illustra- 
tive cases.  Instances  of  persons  who  when  excited  act  as  if 
intoxicated.  Pathological  states  probably  present.  These  con- 
ditions seen  in  other  persons  without  Inherited  predispositions. 
The  fascination  of  some  men  to  hear  of  the  sufferings  of  others. 
Failures  of  temperance  orators  who  use  these  methods.  The  toxic 
states  positive  inheritances  which  take  on  different  forms.  A 
condition  not  studied,  but  explaining  many  of  the  remarkable 
conditions  seen  in  this  class.  It  may  be  concealed,  and  only 
appear  from  the  presence  of  certain  exciting  causes. 

The  special  purposes  of  this  chapter  is  to  group  cer- 
tain facts  and  study  their  relation  to  causes  which  are 
obscure ;  also  to  present  additional  evidence  of  the  tre- 
mendous influence  of  heredity  and  its  most  intimate  asso- 
ciations in  cases  of  inebriety  which  have  never  been 
thoroughly  studied. 

Elsewhere  it  has  been  stated  that  the  evidence  from  a 
clinical  study  of  these  persons  indicates  a  uniformity  in 
development,  progress  and  termination,  and  laws  of  dis- 
solution that  are  fixed  and  certain. 

Two  inmates  of  a  deaf  and  dumb  asylum  exhibited 
such  distinct  symptoms  of  acute  intoxication  as  to  become 
the  subject  of  special  study.  Both  were  boys,  ages  nine 
and  thirteen,  and  both  walked  with  a  staggering  gait 
and  a  peculiar  muscular  tremor.  One  had  a  demented 
grin,  and  nodded  continuously  when  he  observed  anyone 
looking  at  him. 
158 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  159 

The  other  had  a  congested,  blear-eyed  appearance, 
with  a  dull,  vacant  stare  and  expression  of  stupor.  The 
latter  was  very  irritable  and  sensitive  to  observation,  and 
trembled  with  anger  from  any  slight  cause.  The  other, 
after  excitement,  grew  stupid  and  helpless.  These  and 
other  very  distinct  symptoms  of  alcoholic  intoxication 
had  been  noted  from  early  life. 

The  parents  of  both  of  these  boys  were  inebriates, 
and  the  evidence  showed  that  both  were  profoundly 
intoxicated  at  the  time  of  conception.  Further  inquiry 
indicated  that  these  particular  symptoms  were  traceable 
back  to  inebriate  parents,  which  was  by  no  means  uncom- 
mon, especially  in  hospitals  for  idiots  and  feeble-minded. 

It  was  also  evident  that  many  of  these  persons  did  not 
show  such  pronounced  toxic  symptoms  continuously,  but 
only  when  excited  and  subject  to  some  peculiar  stimu- 
lating influences.  A  number  of  these  cases  were  grouped, 
and  seemed  to  divide  into  two  classes — one,  in  which  the 
symptoms  of  intoxication  were  present  all  the  time;  the 
other,  in  which  these  symptoms  only  appeared  from  some 
special,  external  causes. 

In  the  first  class,  idiocy,  imbecility  and  congenital 
deformity  were  present,  and  the  toxic  symptoms  seemed 
to  be  special  manifestations  of  this  condition.  The  spe- 
cial symptoms  of  drunkenness  varied  in  many  partic- 
ulars. Thus,  in  one  examination  at  a  private  school  for 
the  feeble-minded,  four  children  in  fourteen  had  the 
palsied  walk,  red  eyes,  leering  expression,  with  a  sus- 
picious hesitancy  of  manner,  and  other  signs  almost 
pathognomonic  of  intoxication.  In  the  home  of  a  former 
patient  was  an  idiotic  girl,  whose  manner,  walking,  voice 
and  rambling  utterances  were  a  perfect  picture  of  toxic 
states  from  alcohol. 

Other  defects  and  deformities  may  predominate  and 
conceal  some  of  these  special  signs  of  intoxication.  In 


160  INEBRIETY. 

the  cases  examined,  most  of  the  defects  appeared  soon 
after  birth.  Others  were  slowly  evolved  with  the  growth 
of  the  child,  coming  into  prominence  at  or  before 
puberty. 

The  distinctness  of  the  symptoms  and  their  very  close 
resemblance  to  that  of  intoxication  seen  in  the  parents 
suggest  a  direct  causation.  This  was  brought  out  in 
the  case  of  a  lawyer,  who  was  a  periodic  drinker,  and 
while  under  the  influence  of  alcohol  suffered  from  intense 
delusions  of  fear  and  suspicion  of  injury  from  every  one 
with  whom  he  came  in  contact. 

When  the  paroxysm  was  over,  this  passed  away.  His 
idiot  son  exhibited  these  precise  symptoms,  with  or  with- 
out any  exciting  causes,  so  prominently  as  to  indicate 
the  distinct  inheritance. 

In  the  second  class  these  special  alcoholic  symptoms 
appeared  only  from  the  action  of  some  particular,  pe- 
culiar exciting  causes,  such  as  anger,  excitement  or, 
sudden  changes  of  condition  or  environment.  In  two 
instances  this  was  an  exact  duplication  of  the  character 
of  his  mother. 

In  another  instance,  these  alcoholic  symptoms  were 
only  present  when  the  child  was  taken  away  from  the 
home ;  when  quiet  and  still  they  did  not  appear.  Per- 
sons who  have  control  of  idiots  and  imbeciles  realize 
the  danger  of  excitement,  or  anything  startling,  because 
it  develops  all  the  weakness,  delusions  and  delirium. 

Hence  the  effort  to  avoid  anything  that  will  excite 
or  disturb  the  mentality  of  the  child.  Thus  an  imbecile 
boy,  if  watched  sharply,  becomes  confused,  and  acts  and 
appears  as  if  intoxicated.  When  he  becomes  used  to 
the  observation,  these  symptoms  pass  off,  and  he  recovers. 

The  particular  toxic  condition  due  to  alcohol  is  trans- 
mitted to  the  children  and  develops  into  a  like  condition. 
This  is  supported  by  the  history  of  the  parents  and  the 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  161 

special  appearance  of  the  children.  Thus,  in  one  instance, 
a  father  when  intoxicated  had  intense  muscular  delirium, 
in  which  he  moved  about  incessantly,  not  being  able  to 
remain  quiet  for  a  moment.  His  two  children,  who  were 
idiots,  exhibited  the  same  delirium  and  muscular  agi- 
tation from  any  sort  of  excitement.  A  woman,  when 
intoxicated,  had  hysterical  fear  of  dogs.  At  other  times 
she  was  fond  of  them,  and  always  had  them  about 
the  house  as  pets.  She  had  two  imbecile  children,  whose 
fear  of  dogs  was  convulsive,  and  resembled  the  condition 
of  the  mother  when  intoxicated. 

Antenatal  impressions  made  on  the  mother's  mind, 
which  appear  in  the  children,  are  well-attested  facts,  and 
have  been  the  subject  of  considerable  literature.  Two 
instances  bring  out  this  fact  in  a  different  light.  Thus, 
an  exceedingly  nervous  woman,  who  was  a  moderate 
user  of  alcohol,  was  profoundly  frightened  by  an  intox- 
icated soldier.  A  boy  born  soon  after  had  all  the  symp- 
toms of  intoxication,  both  muscular  and  mental,  when- 
ever excited. 

In  the  second  instance  a  mother  saw  her  husband 
wildly  intoxicated,  and  was  very  much  alarmed.  A  boy 
born  soon  after  exhibited  the  same  identical  symptoms 
of  delirium,  stupidity  and  convulsive  toxic  states.  For- 
tunately, there  are  other  causes  which  neutralize  and 
prevent  the  special  development  of  alcoholic  delirium  and 
paralysis. 

It  is  not  clear  why  these  conditions  are  not  apparent 
in  all  children  whose  parents  were  intoxicated  at  the 
time  of  conception.  It  may  be  said  that  while  this  par- 
ticular phase  is  not  always  present,  there  are  other  con- 
ditions of  defects  and  abnormalities  which  are  traceable 
in  many  ways. 

There  is  another  group  of  persons  who  grow  up  and 
are  recognized  as  average  people  with  uniform  health 


INEBRIETY. 


and  capacity,  but  who  from  particular,  exciting  causes 
of  exhaustion,  debility  and  sudden  shock  or  strain,  ex- 
hibit marks  of  alcoholic  intoxication. 

Many  of  these  persons  are  total  abstainers,  reformers 
and  excellent  men  and  women,  who  give  no  evidence  of 
using  spirits  in  any  form,  and  yet  from  some  unexplain- 
able  shocks  or  disease,  appear  to  be  under  the  influence 
of  spirits.  A  careful  study  brings  out  the  fact  of  alco- 
holic ancestors,  and,  of  course,  an  inherited,  neurotic 
weakness. 

In  one  instance  a  man  had  extreme  aversion  for  the 
taste  and  smell  of  spirits,  which  produced  nausea  and 
vomiting  if  forced  to  be  in  the  company  of  drinking 
men  any  length  of  time,  or  to  breathe  air  filled  with 
spirit  odors.  On  several  occasions,  when  suddenly  ex- 
cited, this  man  became  confused,  staggered,  talked  in 
an  imbecile,  boastful  way,  and  gave  all  the  signs  of 
profound  intoxication.  When  taken  to  a  room  and 
allowed  to  become  quiet,  he  recovered  and  appeared  normal 
and  sane. 

Another  example  was  that  of  a  temperate  man  with 
alcoholic  ancestors,  who  showed  great  fear  of  intoxi- 
cated men,  and  sought  every  possible  means  to  keep 
away  from  them,  claiming  that  if  he  could  not  do  so 
he  would  be  like  them.  In  this  instance  he  was  nau- 
seated and  vomited,  showing  signs  of  extreme  depression. 

A  group  of  cases,  bringing  out  some  very  re- 
markable facts,  is  presented,  to  show  the  mysterious  laws 
and  forces  which  are  potent  in  reproducing  toxic  states 
in  children  of  inebriates.  Many  of  these  cases  were  very 
prominent  at  the  time,  and  excited  a  great  deal  of 
attention.  One  J.  B.,  a  man  of  character  and  wealth, 
who  had  never  used  any  kind  of  spirits,  was  greatly 
excited  and  shocked  by  a  runaway,  in  which  he  was 
precipitated  from  the  wagon  and  slightly  bruised. 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  163 

He  could  not  walk.  His  face  became  red,  his  voice 
jerking  and  husky,  and  his  language  impulsive  and  silly. 
He  was  thought  to  be  intoxicated,  and  after  being  taken 
home  recovered.  Later,  at  a  funeral  of  his  child,  he  dis- 
played these  and  other  symptoms  of  intoxication,  to 
the  great  mortification,  of  his  friends  and  family. 

A  year  later  another  similar  attack,  only  more  pro- 
nounced, occurred  at  the  burning  of  some  outbuildings 
on  his  farm.  A  careful  inquiry  showed  that  he  had  not 
used  spirits  in  any  way,  although  every  symptom  indi- 
cated a  toxic  state. 

His  father  was  an  excessive  user  of  spirits,  and  his 
mother  died  of  consumption.  He  never  could  bear  the 
smell  or  taste  of  alcohol,  and  was  greatly  depressed 
from  being  accused  of  drinking. 

A  second  case  was  of  a  treasurer  of  a  large  manufac- 
turing concern.  He  was  strictly  temperate,  but  a  very 
nervous,  hard-working  man.  He  suddenly  appeared  to 
be  intoxicated  when  accused  of  falsifying  the  books.  He 
was  irrational,  delirious  and  stupid.  Was  taken  home, 
and  two  days  after  recovered,  and  explained  his  affairs 
to  the  satisfaction  of  all.  After  a  period  of  invalidism 
for  several  weeks,  he  seemed  to  recover. 

During  the  next  two  years  he  had  two  similar  attacks, 
coming  on  from  excitement  and  unusual  strain.  A  physi- 
cian called  it  congestion  of  the  brain.  In  each  instance 
there  was  no  evidence  of  any  spirits  having  been  used. 
His  father  was  a  sailor,  and  died  from  the  excessive  use 
of  spirits. 

A  third  case  is  of  a  merchant  who  had  lost  all  his  prop- 
erty in  a  series  of  unfortunate  speculations.  He  was 
much  depressed,  and  went  to  live  with  his  brother-in-law, 
a  physician.  He  was  a  total  abstainer  and  a  healthy, 
temperate  man  up  to  the  time  of  his  failure. 


164<  INEBRIETY. 

One  day,  on  the  receipt  of  a  letter  containing  bad 
news,  he  had,  to  all  appearance,  an  attack  of  acute  in- 
toxication. A  careful  examination  showed  that  alcohol 
was  not  used,  and  the  physician  called  it  mind-intoxica- 
tion. From  this  he  recovered  in  a  short  time. 

A  few  weeks  later  a  similar  attack  followed,  and  during 
the  next  five  years  he  had  many  distinct  periods  of  stupor 
and  delirium,  each  one  lasting  from  two  to  four  hours. 
His  ancestors  were  excessive  drinkers  of  spirits.  He  died 
from  acute  pneumonia. 

A  fourth  case  was  that  of  a  banker,  an  abstainer  and 
in  good  health.  One  day  he  received  a  dispatch,  telling 
of  the  sudden  death  of  his  daughter.  In  a  very  short 
time  he  appeared  like  one  wildly  intoxicated.  The  physi- 
cian declared  that  it  was  caused  from  alcohol.  He  was 
taken  home,  and  was  an  invalid  for  two  weeks. 

An  opinion  prevailed  that  he  had  drunk  to  stupor  at 
the  news  of  the  death  of  his  daughter.  There  were  no 
spirits  in  his  office,  and  no  evidence  that  he  sent  out  for 
it,  and  while  he  denied  having  used  spirits,  he  seemed 
greatly  confused  and  excited  at  his  condition  and  the 
accusations  that  were  made.  Both  cf  his  parents  drank 
excessively,  but  there  was  no  evidence  of  his  having 
used  spirits. 

An  incident  occurred  during  the  late  war,  and  was 
the  subject  of  much  comment  and  speculation.  A  prom- 
inent officer  appeared  intoxicated,  riding  up  and  down 
the  firing  line,  shouting  parts  of  songs  and  orders  with 
wild  exclamations.  His  conduct  was  so  strange  and  un- 
usual that  he  was  ordered  back,  but  not  until  he  had 
two  horses  shot  under  him,  and  was  slightly  wounded 
himself. 

In  reality  he  was  a  total  abstainer,  and  had  not  drunk 
any  spirits.  The  excitement  of  the  occasion  seemed  to 
have  brought  on  a  species  of  frenzy  which  resembled 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  165 

acute  intoxication.  Surgeons  have  noted  this  strange 
delirium  and  peculiar  excitement  in  men  under  fire,  so 
exactly  like  intoxication,  although  it  was  impossible  to 
discover  where  the  men  had  obtained  spirits. 

Several  authors  have  mentioned  similar  incidents  of 
soldiers  previously  temperate  who  suddenly  appeared  de- 
liriously intoxicated,  and  after  the  battle  was  over  be- 
came stupid  and  bewildered,  and  showed  irritability  and 
other  symptoms  so  common  from  the  toxic  action  of 
alcohol. 

Instances  are  mentioned  after  periods  of  prolonged 
strain  and  excitement,  where  large  quantities  of  coffee 
were  given  out.  Many  men  showed  unmistakable  symp- 
toms of  drunkenness,  which  was  termed  "coffee  drunks." 
This  was  marked  by  excitement  and  frenzy,  or  stu- 
pidity and  unconsciousness  of  danger,  which  was  not 
bravado,  but  a  sort  of  a  delirious  recklessness  that  fre- 
quently ended  in  capture  and  death. 

An  author,  in  writing  of  a  particular  battle,  men- 
tioned that  after  giving  out  large  quantities  of  coffee 
to  a  certain  division  on  an  exposed  position,  the  men 
showed  a  recklessness  and  frenzy  that  was  very  marked. 
The  same  facts  have  been  observed  in  the  navy  where 
men,  subjected  to  protracted  excitement,  have  become 
wild  and  stupid,  and  the  term  "battle  drunks"  was  used 
to  describe  this  condition. 

Upon  the  advent  of  great  disasters  many  persons  are 
shocked,  greatly  excited,  act  irrationally,  do  extraor- 
dinary tilings,  and  seem  to  be  practically  drunk  and 
idiotic. 

In  a  railroad  accident  the  conductor  of  the  train 
appeared  and  acted  like  one  intoxicated,  although  he 
had  never  used  any  spirits.  Two  men,  riding  on  a  train, 
talking  quietly,  were  suddenly  precipitated  down  an 
embankment.  The  cars  were  crushed  and  manv  were 


166  INEBRIETY. 

killed.  These  two  men  were  only  slightly  bruised.  One  of 
them  became  stupid,  excited  and  apparently  intoxicated, 
and  his  condition  was  the  subject  of  a  good  deal  of 
comment  afterwards. 

These  cases  occur  not  unfrequently,  but  for  want  of 
accurate  observation  and  difficulty  of  obtaining  the  facts, 
are  seldom  studied,  but  rather  concealed,  on  the  suppo- 
sition that  they  would  reflect  on  the  character  of  the 
person.  The  histories  of  all  the  cases  which  have  so  far 
been  studied  indicate  inebriate  ancestors  and  a  pronounced 
entailment  of  heredity,  which  some  special,  exciting 
causes  have  materialized  into  a  form  of  apparent  alco- 
holic intoxication. 

It  is  a  reasonable  inference  where  symptoms  of  intox- 
ication in  the  general  sense  appear,  and  no  active,  excit- 
ing causes  can  be  found,  to  expect  a  similar  condition 
in  ancestors.  It  is  a  fact  based  on  a  large  experience 
that  inherited  defects  may  pass  down  several  generations 
and  be  dormant,  only  appearing  from  the  action  of  some 
peculiar,  exciting  causes. 

Another  group  of  cases  have  come  under  observation, 
in  which  persons  who  have  previously  been  inebriates,  or 
who  have  drunk  to  intoxication,  and  then  become  total 
abstainers,  develop  suddenly  all  the  signs  of  intoxication 
without  having  used  any  form  of  spirits. 

Most  of  these  cases  show  heredity  and  alcoholic  ances- 
tors one  or  two  generations  back.  The  following  cases 
seem  to  sustain  this  conclusion:  A  man  of  some  prom- 
inence, who  drank  during  his  college  life,  then  became 
a  total  abstainer,  and  for  fifteen  years  afterwards  lived 
a  temperate,  healthy  life,  above  all  suspicion,  became 
engaged  in  marriage  under  circumstances  of  great 
promise. 

The  day  of  the  wedding  the  bride  received  a  letter 
of  warning,  saying  that  he  was  a  secret  drinker  and  a 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  167 

bad  man  otherwise.  This  letter  was  sent  to  him.  After 
reading  it  he  showed  all  the  signs  of  intoxication  and 
went  to  bed,  and  for  two  days  was  under  the  care  of  the 
physician.  He  asserted  so  positively  his  innocence  that 
medical  examination  of  the  facts  was  called  for.  This 
showed  no  signs  of  the  use  of  spirits,  and  confirmed  his 
assertion  of  not  having  used  any  alcohol  or  any  similar 
drugs.  A  history  of  moderate  and  excessive  drinking 
was  noted  in  his  parents. 

A  second  case  in  which  a  clergyman  had  a  marked  his- 
tory of  heredity  was  taken  to  a  hospital  for  inebriates. 
A  few  months  later,  while  still  under  treatment,  he  was 
visited  by  a  brother  clergyman,  who  no  doubt  talked 
very  severely  to  him  about  the  sin  of  drinking.  He  was 
found  a  short  time  after  apparently  intoxicated,  and 
for  two  days  he  had  all  the  appearances  of  one  who 
had  been  profoundly  poisoned  by  alcohol.  This  case 
was  also  the  subject  of  very  careful  study,  and  his  asser- 
tions of  not  having  had  any  spirits  were  sustained,  and 
the  conclusion  that  the  excitement  precipitated  a  pathol- 
ogical state  resembling  intoxication,  was  conclusive. 

A  third  case  was  the  subject  of  a  great  deal  of  con- 
troversy. The  facts  were  these: 

A  temperance  lecturer  in  early  life  had  drunk  to 
excess,  but  for  over  twenty  years  had  been  a  total 
abstainer  and  reformer.  One  evening  while  lecturing 
he  was  handed  a  dispatch,  announcing  the  fatal  illness 
of  his  only  child.  He  drank  a  glass  of  water,  attempted 
an  explanation,  became  confused,  staggered  and  acted 
like  a  man  becoming  intoxicated.  He  was  led  from  the 
stage,  and  laughed  and  shouted  in  a  maudlin  way. 

The  audience  supposed  that  he  was  drunk.  He  was 
put  to  bed  and  several  hours  later  recovered.  All  cir- 
cumstances showed  that  he  had  used  no  spirits,  but  was 


168  INEBRIETY. 

suffering  from  some  sort  of  a  brain  disturbance  which 
took  on  this  peculiar  form. 

In  another  instance,  an  eloquent  lecturer,  who  por- 
trayed with  great  dramatic  skill  the  conduct  and  manner 
of  an  inebriate,  and  the  terrible  losses  which  follow  from 
his  conduct,  would  be  practically  intoxicated  at  the  con- 
clusion of  his  lecture,  and  be  taken  away  to  some  quiet 
hotel  room  and  kept  from  observation  for  several  hours. 

This  man  came  from  alcoholic  ancestors,  and  drank 
early  in  life,  then  abstained,  and  for  many  years  has  been 
recognized  as  a  very  unusual  speaker  in  the  temperance 
field,  and  is  employed  constantly. 

The  necessity  of  having  him  go  to  a  room  immedi- 
ately after  the  lecture  has  been  more  and  more  prom- 
inent the  last  few  years.  Phases  of  exhaustion,  called 
queer  spells  by  his  friends,  and  by  others  called  intoxi- 
cation, are  very  significant,  and  indicate  a  degenerative 
neurosis  that  is  increasing. 

Another  example  was  that  of  a  clergyman  of  much 
talent  and  genius,  who  drank  during  college  life,  then 
abstained.  At  about  forty-five  years  of  age  he  became 
subject  to  impulses  to  drink,  which  could  be  overcome 
or  restrained  by  preaching  temperance  sermons  and  seek- 
ing opportunities  to  talk  and  plead  with  persons  to 
become  total  abstainers. 

He  finally  gave  up  the  pulpit  and  became  a  temper- 
ance lecturer,  exhibiting  great  power,  enthusiasm  and 
dramatic  skill  in  persuading  people  to  abstain  from 
spirits.  After  giving  a  lecture  his  condition  resembled 
closely  one  who  had  been  profoundly  intoxicated.  He 
had  to  be  put  to  bed  and  cared  for  as  one  who  was  ut- 
terly incompetent  to  know  and  reason  what  he  should  do. 

These  were  likewise  called  "queer  spells."  After  the 
meeting  he  was  irritable  and  harsh,  and  wanted  to  be 
taken  away,  and  said  in  an  undertone  to  his  friends 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  169 

that  he  wanted  to  get  drunk,  and  must  have  some  spirits, 
unless  they  could  take  him  away  where  it  was  quiet. 

These  examples  indicate  a  wide  range  of  facts  which 
may  be  studied  in  the  temperance  meetings  of  to-ddy, 
particularly  where  conducted  by  reformed  inebriates  and 
persons  who  have  had  serious  experiences. 

There  is  another  series  of  pathological  conditions 
noted  in  what  may  be  called  unconscious,  imitative  ine- 
briety, in  which  persons  appear  intoxicated  from  the 
influence  of  contagion  in  the  surroundings  and  from 
personal  contact  with  drinking  men. 

These  cases  have  all  a  strong  substratum  of  heredity. 
That  is,  they  come  from  inebriate  ancestors,  and  have  a 
peculiar  neuropathic  diathesis.  The  following  is  an 
example : 

A  lawyer,  a  delicate,  nervous  man,  was  employed  in 
the  State  Department  at  Washington,  where  a  monoto- 
nous, exact  range  of  duties  was  performed  for  years. 
He  lived  a  temperate  life,  never  having  used  spirits,  al- 
though his  father  was  an  inebriate.  His  evenings  were 
spent  at  the  club,  where  he  read  a  great  deal,  played 
cards  and  appeared  the  same  as  others. 

Suddenly  it  was  noticed  that  he  appeared  like  a 
drinking  man,  particularly  when  in  the  company  of 
those  who  used  spirits.  If  any  of  them  became  hilarious 
or  stupid,  he  would  appear  the  same,  although  he  did 
not  drink  anything  but  water,  and  refused  with  firm- 
ness all  invitations  to  drink. 

Sometimes  he  drank  coffee  or  a  mild  cup  of  tea.  As 
the  company  grew  intoxicated  he  appeared  like  them,  and 
sometimes  would  have  to  have  a  carriage  to  take  him 
home.  The  next  morning  he  would  complain  of  a  head- 
ache. These  occasions  increased  in  frequency,  until 
finally  it  was  impossible  for  him  to  be  in  the  company 
of  drinking  men  without  appearing  and  acting  like  them. 


170  INEBRIETY. 

His  friends  called  him  a  "coffee  drunkard."  He  could 
give  no  explanation  of  his  condition,  and  it  was  noticed 
that  he  was  not  affected  by  the  contagion  of  drinking 
men  who  were  strangers,  but  those  whom  he  knew  in- 
fluenced him  very  markedly. 

He  affirmed  that  the  sensation  from  the  company  of 
drinking  men  was  very  pleasant,  and  that  he  followed 
them,  apparently  enjoying  their  excitement  and  stupor 
without  realizing  what  it  was  until  the  party  broke  up 
and  he  started  for  home.  Then  the  palsy  and  stiffness 
of  the  joints  and  general  disgust  appeared.  This  would 
last  until  the  next  day,  although  he  was  not  aware  of 
using  any  spirits  himself. 

He  was  the  subject  of  a  very  careful  study  by  two 
medical  men,  who  concluded  that  it  was  a  pure  case  of 
hypnotic  influence  and  suggestion,  and  that  he  was  a 
perfect  barometer  of  the  surroundings  and  influences 
of  others,  and  that  after  a  certain  time  he  lost  all  memory 
of  what  he  was  doing,  or  consciousness  of  the  conditions. 

This  man  left  the  club  and  recovered,  but  he  was 
very  careful  to  keep  away  from  all  drinking  men,  be- 
cause of  the  certainty  of  taking  on  their  exact  condi- 
tions. 

A  second  example  was  a  farmer.  He  was  a  strong 
temperance  man,  and  was  elected  to  Congress.  He 
formed  a  strong  attachment  for  an  impulsive,  drinking 
man  in  the  same  body,  and  associated  with  him  freely, 
although  never  using  spirits  of  any  kind. 

It  was  noticed  that  he  would  stagger,  talk  wildly, 
laugh  and  tell  stories,  and  exactly  reproduce  many  of 
the  manners  of  this  man.  Later  he  imitated  conditions 
of  intoxication,  and  was  hilarious  and  stupid.  The  only 
thing  that  fixed  itself  on  his  mind  was  that  he  could 
not  use  spirits.  He  was  reported  as  intoxicated,  and  had 
difficulty  in  making  a  reasonable  defense. 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  171 

Whenever  in  company  with  this  man,  where  wine  was 
used,  and  the  party  was  hilarious,  he  was  considered  in- 
toxicated with  the  others.  He  was  re-elected  and  his 
companion  died.  After  this  his  manner  changed,  and 
he  avoided  the  society  of  drinking  men  and  dinners  where 
wines  were  served. 

Both  of  these  persons  had  an  alcoholic  ancestry,  and 
both  were  temperate  men.  Another  group  of  examples 
were  reformed  men,  or  persons  who  had  previously  drunk 
and  become  abstainers,  who  showed  the  same  signs  of  in- 
toxication from  contagion. 

The  following  is  an  instance:  A  military  man  had 
drunk  moderately  during. the  war,  but  had  been  a  total 
abstainer  for  many  years.  While  attending  a  dinner 
with  his  old  comrades,  where  most  of  them  were  intoxi- 
cated, he  suddenly  became  hilarious,  made  a  wild,  foolish 
speech,  settled  back  in  his  chair,  evidently  as  drunk  as 
the  others. 

In  reality  he  had  not  used  any  spirits,  but  simply 
coffee  and  water,  and  yet  he  had  all  the  symptoms  of 
intoxication,  due  to  the  contagion  of  the  surroundings. 

Another  example  was  of  a  man  who  had  been  a  total 
abstainer  for  more  than  twenty  years.  He  was  elected 
to  office  and  gave  a  dinner  in  honor  of  this  event.  Many 
of  the  company  at  the  dinner  became  intoxicated,  and 
the  host  who  drank  nothing  but  water  became  boisterous 
with  the  others,  then  stupid,  and  had  every  sign  of  in- 
toxication. He  was  carried  home  in  a  semi-paralyzed 
condition,  and  the  next  morning  had  only  a  confused 
notion  of  what  had  occurred. 

A  physician  who  was  present  was  able  to  make  a  study 
of  his  condition,  and  declared  that  he  had  a  mental  in- 
toxication, and  that  his  condition  was  one  of  pure  hyp- 
notic contagion  from  the  surroundings. 


172  INEBRIETY. 

A  third  case  was  of  a  reformed  man  who  had  been  a 
total  abstainer  for  twelve  years.  He  went  on  a  military 
excursion,  and  most  of  the  company  became  more  or  less 
intoxicated.  He  appeared  like  the  others — maudlin, 
wild  and  delirious — although  he  drank  nothing  but 
lemonade. 

The  event  was  the  subject  of  comment  and  an  occasion 
of  loss,  socially  and  otherwise.  A  careful  examination  of 
all  the  facts  showed  that  he  did  not  drink  any  spirits, 
and  that  his  condition  was  simply  one  of  mental  contagion. 

These  three  examples  were  studied  by  most  competent 
authorities,  and  the  conditions  were  beyond  all  question 
and  doubt.  The  previous  examples  were  persons  who 
had  never  drunk,  but  exhibited  a  distinct  pathological 
inheritance.  The  latter  cases  show  a  materialization  of 
some  previous  pathological  state.  What  form  of  brain 
and  nerve  defects,  either  acquired  or  inherited,  could  be 
made  prominent  by  contagion  or  suggestion,  is  a  ques- 
tion for  future  studies. 

In  a  less  prominent  way,  similar  conditions  have  been 
noticed  in  club  rooms  and  at  banquets  and  dinners  where 
wines  were  very  freely  used.  Men  and  women  who  are 
not  drinking  spirits,  not  unfrequently  show,  with  others, 
very  unusual  symptoms  of  weakness  and  childishness, 
resembling  persons  under  the  influence  of  spirits ;  and 
afterwards  express  regret  and  inability  to  account  for 
their  acts  or  conduct. 

There  are  some  very  striking  psychological  facts  along 
this  line  that  explain  many  of  the  phenomena  of  ab- 
normal or  unusual  mental  states.  It  is  said  in  theatri- 
cal circles  that  actors  who  make  the  best  representations 
of  insanity  or  inebriety  have  inherited  some  nervous 
organization  or  peculiarities  predisposing  them  to  enter 
into  the  spirit  and  condition  of  the  character  they 
portray. 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  173 

A  single  glass  of  spirits  may  awaken  some  latent 
nerve  defect  which  very  quickly  leads  up  to  inebriety. 
So  the  effort  to  imitate  the  manner  and  conduct  of  an 
intoxicated  person  gives  a  certain  impress  and  direction 
to  the  functional  activities  of  the  body  that  sooner  or 
later  become  permanent.  Actors  who  have  been  intox- 
icated and  who  are  moderate  drinkers  give  a  certain 
realism  to  their  representations  of  drunken  men  that 
cannot  be  mistaken. 

It  has  been  said  that  persons  of  this  class  who  rep- 
resent intoxicated  states  are  intensely  depressed  after- 
wards, and  claim  that  they  feel  worse  than  they  do  from 
the  real  condition.  In  an  instance  where  an  actor  daily 
represented  an  intoxicated  man  for  a  season,  he  had  to 
give  it  up,  because  of  its  tremendous  influence  on  his 
character  and  conduct.  He  could  not  use  spirits  in  the 
play,  for  the  reason  that  his  memory  would  be  disturbed 
and  his  artistic  sense  impaired. 

A  temperance  writer  of  great  power  and  vividness  of 
detail  said  that  in  describing  the  effects  of  drink  and 
drinking  men,  he  entered  so  deeply  into  the  conditions 
of  exhaustion,  pain,  agony  and  joyousness,  which  he 
described,  that  he  had  to  go  to  bed,  as  he  was  prac- 
tically intoxicated. 

This  man  was  strictly  temperate.  He  had  an  inebri- 
ate father,  from  whom  he  inherited  a  peculiar  nervous 
organization,  which  enabled  him  to  realize  the  toxic 
states  from  alcohol  and  describe  them  with  vividness. 
He  gave  up  writing  on  this  theme  because  it  was  so 
intimately  associated  with  his  mental  health. 

Descriptions  of  drunken  men  in  novels  bring  out 
this  fact  very  clearly.  Either  the  writer  has  had  some 
personal  experience  or  his  ancestors  before  him  have 
impressed  on  his  organism  a  vivid  and  intense  concep- 


17-i  INEBRIETY. 

tion  of  the  toxic  states,  or  else  their  pictures  are  unreal 
and  mechanical  word-settings. 

Those  who  study  inebriates  carefully  are  continually 
astonished  at  the  reproduction  of  ancestral  traits  and 
peculiarities,  dating  back  two  or  three  generations  some- 
times. One  is  also  astonished  at  the  psychological  man- 
ifestations and  reproductions  of  previous  mental  condi- 
tions in  persons  who  are  total  abstainers. 

For  instance,  reformed  men,  or  those  who  have  stopped 
all  use  of  spirits,  are  often  very  sensitive  to  the  recital 
of  the  struggles  of  others  under  the  influence  of  drink. 
Such  narratives  often  take  on  the  form  of  a  mental  shock 
that  have  much  to  do  in  diminishing  their  strength  and 
vigor. 

Temperance  lecturers  who  expect,  by  drawing  vivid 
pictures  of  the  horrors  of  alcoholic  excess,  to  create  a 
similar  sentiment  in  the  minds  of  the  hearers,  often  pro- 
duce the  very  opposite  effect,  particularly  in  persons 
who  have  inherited  a  defective  nervous  organization 
from  alcoholic  ancestors.  In  much  the  same  way,  the 
sight  of  intoxicated  persons  produces  a  dangerous  sort 
of  excitement  in  the  minds  of  defects  and  a  species  of 
contagion,  or  rather  fascination  to  imitate  them. 

The  conclusion  must  be  recognized  that  a  pronounced 
toxic  condition  from  alcohol  leaves  a  permanent  impres- 
sion on  the  organism  which  may  be  concealed  for  a 
time,  but  is  very  likely  to  appear  again  on  the  appli- 
cation of  some  special  exciting  causes. 

There  are  evidently  conditions  of  heredity,  unknown 
at  present,  which  will  be  studied  in  the  future.  Two 
facts  seem  to  be  clear.  First,  that  symptoms  of  alco- 
holic poisoning  may  occur  when  no  alcohol  has  been 
used. 

Second,  that  the  excessive  use  of  alcohol  leaves  a  per- 
manent impression  on  the  brain,  both  physiological  and 


PSYCHIC  PHENOMENA  OF  INEBRIETY.  175 

psychological.  This  impression  may  go  on  down  to  the 
next  generation,  and  in  some  unforeseen  way  appear  in 
conduct  and  actions,  and  can  be  traced  back  to  the  orig- 
inal cause. 

The  impression  made  of  every  event  on  the  mind  and 
experience  is  exact  and  indelible,  and  when  any  sufficient 
suggestion  is  made  out  of  the  unknown  changes  of  the 
past  life,  the  old  emotion,  conduct  and  mental  states 
will  appear,  and  their  return  is  full  of  peril  to  the  en- 
feebled and  weak  ones. 


CHAPTER  XVII. 
PATHOLOGY  OF  INEBRIETY. 


Exact  changes  difficult  to  determine.  Under  the 
microscope  confused  wreckage  of  cells  and  nerves  ap-parent. 
First  changes  in  the  blood  vessels.  Many  persons  die  of  acute 
inflammatory  diseases.  The  pathology  varies  widely  in  these 
cases.  Vaso-motor  paralysis  a  very  common  condition.  Defective 
nutrition  with  diminution  of  powers  of  elimination  and  accumu- 
lation of  toxins  are  common.  Conclusions  of  the  London  Patho- 
logical Society.  Dr.  Andriesen's  opinions.  Studies  of  Dr.  Berk- 
ley and  Dr.  Van  Gieson.  Derangement  of  circulation  of  the  brain 
an  early  symptom.  Destruction  of  the  protoplasm  common.  Dr. 
Sims  Woodhead's  opinion.  Thinks  liver  and  other  organs  suffer 
uniformally.  Nutrition  of  the  heart  impaired.  Every  intoxication 
a  paralysis.  Post-mortems  show  ruptures  and  occlusions.  Dr. 
Bevan  Lewis  points  out  congestion  and  shrinking  of  cells  and 
blood  vessels  as  common.  Psychic  palsies  leave  marked  effects. 
Heredity,  susceptibility  and  immunity  conditions  to  be  consid- 
ered. The  modern  pathologist  finds  a  great  variety  of  degen- 
erative changes.  Other  experts  point  out  changes  of  functional 
activity,  sensory  actions,  structural  pathology  often  mistaken 
in  their  conclusions.  Functional  pathologists  determine  causes 
very  distinct.  Conclusions.  Much  to  be  learned.  Great  problems 
to  be  settled. 

The  pathology  of  inebriety  is  an  obscure  record  of  a 
long  series  of  shocks,  injuries,  degenerative  changes  and 
explosive  liberations  of  nerve  energy,  often  beginning 
with  defective  cells  and  growths,  and  going  on  for  years. 

Of  necessity  there  must  be  great  complexities  of  re- 
sults from  the  innumerable  causes  and  varied  influences 
which  register  themselves  on  the  cells  and  tissue  of  the 
body. 

The  brain  and  body  of  the  inebriate  under  the  micro- 
scope often  exhibit  at  the  post-mortem  a  confused  wreck- 
age of  cells  and  nerves  and  walls  of  blood  vessels,  thick- 
ening and  thinning  of  tissues,  so  that  the  pathologist  is 
unable  to  trace  the  exact  causes  which  have  produced 
this  or  that  result. 

Usually  degenerations  most  prominent  are  sclerosis 
and  calsification  of  the  couts  of  the  arteries,  with  atrophic 
176 


PATHOLOGY  OF  INEBRIETY.  177 

and  hyperatrophic  states  of  the  organs,  and  other  defects. 
These  are  so  common  in  inebriates  that  they  are  regarded 
as  pathologic  and  traceable  to  the  excessive  use  of 
alcohol. 

In  reality,  a  large  number  of  inebriates  die  from  acute 
diseases  which  are  local  in  their  action.  The  post-mortem 
reveals  many  organic  changes  which  are  commonly  trace- 
able to  alcohol;  yet  there  are  many  cases  of  pronounced 
inebriates  dying  from  acute  inflammatory  diseases  where 
the  pathological  changes  are  very  indistinct,  and  might 
be  referable  to  other  causes. 

The  more  modern  views  of  the  action  of  alcohol  indi- 
cate that  the  first  pathological  changes  are  recorded  in 
the  walls  of  the  blood  vessels,  particularly  in  the  capil- 
laries of  the  brain  and  surface  of  the  body.  The  well- 
known  action  of  alcohol  on  the  vaso-motor  centers,  par- 
alyzing and  diminishing  the  muscular  contractivity  of  the 
arteries  and  capillaries  obstruct  and  change  the  action 
and  uniformity  of  the  blood  current.  This  is  followed 
by  defective  nutrition,  with  accumulation  of  toxins  and 
a  diminution  of  the  power  of  elimination. 

The  conclusions  of  the  London  Pathological  Society 
have  been  sustained  by  all  modern  studies,  and  agree  that 
the  first  action  of  alcohol  in  the  body  is  to  check  oxidiza- 
tion by  diminishing  the  oxygen-carrying  properties  of 
the  hemoglobin  and  retarding  the  elimination  of  carbon- 
dioxide. 

Another  action  is  that  of  a  corroding  tissue  poisoning 
by  the  absorption  of  water  at  every  point  of  contact 
with  the  cells  and  tissues. 

A  third  action  is  marked  functional  derangement,  noted 
in  the  depression,  checking  and  retarding  the  natural 
activities  of  the  organism.  The  corroding  effects  on  the 
cells  and  nerves  provokes  inflammatory  action  with  fibrin- 
ous  deposits,  and  these  are  very  common. 


178  INEBRIETY. 

Dr.  Andriesen,  the  pathologist  of  the  West  Riding 
Asylum,  in  England,  concludes  an  exhausting  study  of 
the  injuries  following  the  use  of  alcohol,  as  follows: 

"There  can  be  no  doubt  that  alcohol  taken  into  the 
body  has  a  specific  influence  over  the  nutrition  of  the 
nerve  cells,  impoverishing  and  starving  them,  cutting  off 
and  diverting  the  dynamic  forces.  This  is  followed  by 
shrinking  and  atrophy  of  both  cell  and  nerve." 

Dr.  Berkley,  of  Johns  Hopkins  Hospital,  has  added 
new  studies  of  his  own  to  these  conclusions,  proving  that 
alcohol  has  a  special,  corroding  action  on  the  cells,  not 
only  paralyzing  them,  but  abstracting  the  water  from 
them,  and  thus  destroying  their  activity.  This  may  be 
confined  to  certain  local  centers,  which  later  increases 
until  large  areas  of  the  brain  become  affected. 

Dr.  Van  Gieson,  late  of  the  New  York  Pathologic  In- 
stitute, has  described  the  altered  conditions  of  the  blood 
cells  and  fibers  following  the  use  of  spirits,  reaching  the 
same  conclusions  that  the  corroding  action  of  spirits  is 
apparent  on  the  protoplasm  and  the  nutritive  activities 
of  the  cells. 

In  support  of  these  general  statements  a  great  variety 
of  studies  have  been  made,  not  only  confirming  them,  but 
adding  many  new  facts.  One  author  believes  that  the 
paralyzing  action  of  alcohol  on  the  capillaries  breaks  up 
the  uniform  flow  of  the  blood  current,  producing  con- 
vulsive, irregular  activities,  which  is  the  first  and  most 
pronounced "  pathologic  change. 

The  very  apparent  action  of  alcohol  in  increasing  the 
heart's  action  and  flow  of  blood,  is  always  followed  by 
a  diminution  of  both  the  heart  force  and  circulatory 
power  after  a  time.  This  may  be  so  pronounced  as  to 
cause  great  alternations  of  exhiliration  and  activity,  fol- 
lowed by  depression  and  stupor. 


PATHOLOGY  OF  INEBEIETY.  179 

It  is  from  these  conditions  that  nutrition  is  disturbed 
and  irritation  encouraged,  apparent  in  certain  brain 
tracts  and  in  certain  persons  who  are  susceptible  to 
these  influences. 

The  spasmodic  activity  of  the  heart  from  the  use  of 
spirits  varies  widely  in  different  persons.  In  one  person 
the  beats  will  increase  ten  or  fifteen  a  minute.  In  an- 
other, after  a  brief  time,  the  number  will  decrease,  and  a 
decidedly  sedative  action  will  appear.  In  all  cases  there 
is  a  lowering  of  the  functional  activity,  and  with  it 
increase  of  toxins  and  diminished  nutrition.  These  con- 
ditions may  be  caused  by  toxaemias  of  a  gastro-intestinal 
origin,  and  may  be  very  active  in  producing  similar  re- 
sults in  susceptible  persons. 

The  corroding  action  of  alcohol  may  be  intensified 
by  toxic  products  from  various  sources.  Syphilis  is  a 
degenerative  poison,  diminishing  the  resistive  power  of 
the  brain  and  stimulating  acute  organic  degenerations. 
All  writers  agree  that  the  specific  vaso-motor  paralysis, 
due  to  alcohol,  is  the  beginning  of  organic  changes  in 
the  capillaries,  and  this  is  felt  in  the  nerve  cells. 

The  power  of  contraction  and  dilation,  so  prominent 
in  the  heart,  extends  to  the  minutest  blood  vessels,  and 
is  literally  a  force  that  controls  the  blood  pressure,  reg- 
ulating the  rythmic  flow  of  the  current,  governed  by 
the  influence  of  heat  and  cold,  irritation,  rest,  nutrition 
and  other  causes. 

Hence,  the  disturbance  of  the  heart  is  registered  as 
an  impairment  of  the  circulatory  movement  of  the  blood 
in  all  parts  of  the  body.  This  process  impairs  oxidiza- 
tion, nutrition  and  elimination,  and  this  finally  is  regis- 
tered in  fibrinous  deposits  and  changes  in  the  large  and 
small  vessels. 


180  INEBRIETY. 

Arterial  sclerosis  is  a  condition  very  common  in  in- 
ebriates, and  is  a  very  natural  result  of  diminished 
elimination,  defective  nutrient  plasm  and  desposits  of 
waste  matters.  The  congested  appearance  of  the  face 
in  persons  using  spirits  is  a  good  index  of  the  derange- 
ment of  circulation. 

Both  the  vaso-dilators  and  the  vaso-constrictors  suffer, 
and  the  blood  current  is  interfered  with,  and  finally  per- 
manent paralysis  follows.  The  nutrition  of  the  arteries 
is  changed,  and  the  muscle  cells  are  replaced  by  fibrinous 
deposits,  the  channel  is  interfered  with,  and  the  supply 
of  nutrients  deranged. 

Dr.  Sims  Woodhead,  the  noted  Cambridge  pathologist 
of  England,  says: 

"I  have  been  able  to  demonstrate  that  the  walls  of  the 
blood  vessels  are  the  first  to  suffer  organic  change  from 
the  action  of  alcohol.  Such  changes  occur,  first,  by  a 
thickening  of  the  inner  coat,  followed  by  proliferation 
of  the  endothelial  cells.  Then  a  thickening  of  the  media 
and  the  adventitia,  also  wasting  of  the  muscular  fibers. 
This  cellular  increase  is  a  veritable  connective  tissue  group 
of  degenerations.  First,  it  is  a  proliferation  of  the 
endothelial  and  connective  tissue  cells,  around  the  con- 
nective tissue  spaces,  and,  secondly,  it  is  an  accumulation 
of  waste  products. 

"This  may  go  on  slowly  or  rapidly.  Often  it  attacks 
the  liver  or  the  kidneys,  always  affecting  the  parenchyma- 
tous  tissues.  These  changes  also  affect  the  capillaries  of 
the  brain,  in  the  chronic  form,  the  muscular  coats  of 
the  walls  disappear,  and  fibrinous  tissue  take  their  place. 

"The  liver  cells  become  atrophied,  and  fatty  infiltration 
with  degenerations  follow.  This  formation  of  fibrinous 
tissues  is  particularly  uniform  in  the  heart,  kidney,  liver, 
blood  vessels  and  sheaths  of  the  nerves.  The  lymphatics 
are  also  affected." 


PATHOLOGY  OF  LNEBBIETY.  181 

The  spasmodic  and  convulsive  activity  of  the  heart 
always  deranges  the  nutrition  of  that  organ.  The  cori- 
nary  artery  is  diminished  in  caliber  and  capacity  to  trans- 
mit the  blood  current.  Hence  the  increase  action  of 
the  heart  is  followed  by  exhaustion.  This  is  registered 
in  the  atrophic  and  hypertrophic  conditions  of  the 
heart. 

Dilation  of  the  heart  results  simply  from  deposits  of 
fatty  cells  in  the  place  of  the  muscular  fiber,  whereby  its 
action  and  power  of  contraction  is  diminished.  Both  the 
liver  and  kidneys  suffer  in  the  same  way  from  increased 
work  and  diminished  nutrition. 

The  arteries  and  capillaries  suffer  in  the  same  way, 
by  both  thinning  and  thickening  of  the  walls.  In  post- 
mortems of  drinking  men  the  brain  often  shows  occlu- 
sions, ruptures  and  collateral  circulation.  These  are  the 
direct  result  of  spirits  and  the  organic  changes  in  the 
walls  of  the  arteries. 

Every  intoxication  from  alcohol  is  a  paralysis,  usually 
spasmodic,  or  otherwise,  of  the  arteries,  with  a  diminution 
of  nutrition  and  other  disturbances.  This  may  be  both 
local  and  general.  The  stupor  and  coma,  and  the  ex- 
citement, delirium  and  delusions  indicate  physical  de- 
rangement. 

It  is  also  due  to  the  irritant  action  of  the  toxins  or 
pressure  of  congested  blood  on  certain  centers.  Other 
poisons  circulating  in  the  blood  may  have  a  similar 
action,  producing  contraction  and  tumefaction  of  the 
cells  and  followed  by  increasing  fibrinous  growths. 

Dr.  Bevan  Lewis  has  described  this  condition  at  length, 
showing  how  toxins  produce  congestion  and  contraction, 
and  thus  causing  a  shrinking  of  the  cells  in  the  blood 
vessels.  The  serum  infiltrations  commonly  found  in  the 
brain  of  persons  who  use  alcohol,  together  with  the 


182  INEBEEETY. 

fibrous  arteries  and  sclerosis  of  the  nerves  and  capillaries, 
also  of  the  liver  and  kidneys,  constitute  a  distinct  path- 
ology, which  is  more  or  less  common  to  all  inebriates. 

The  older  pathologists,  whose  experience  was  gained 
from  the  cadaver,  pointed  out  the  uniformity  of  the 
fibrinous  deposits,  serum  infiltrations  and  calsification  of 
the  arteries  with  foci  of  old  hemorrhages  as  an  unmis- 
takable indication  of  alcoholic  excesses. 

Why  one  organ  should  suffer  more  seriously  from  or- 
ganic changes  than  any  other,  and  why  the  heart  should 
become  hypertrophied  and  the  liver  and  kidneys  show 
little  change,  except  in  their  functional  activities,  and 
vice  versa,  must  be  answered  in  the  future. 

Why  inebriates  show  very  little  organic  change  with 
great  functional  debility  is  another  problem  for  the 
future.  There  is  evidently  a  pathology  beyond  the 
microscopic  power  to  determine ;  that  it  is  organic  there 
can  be  no  question. 

Another  pathological  view  of  what  is  termed  psychic 
causes,  is  far  more  common  and  uniform  than  specific 
gross  organic  changes.  It  is  uncertain  whether  these 
psychic  palsies  follow  or  precede  the  organic  changes  in 
the  circulation  and  nutrition. 

A  very  interesting  chapter  is  yet  to  be  written  on 
the  palsies  noted  in  inebriates,  particularly  of  organic 
and  functional  activities  of  the  body.  In  many  instances 
psychic  changes  of  character  and  conduct  are  traceable 
to  faulty  nutrition  and  shocks,  following  sudden  accumu- 
lation, liberation  and  change  of  nerve  energy. 

The  uniform  paralysis  and  depression  of  the  sensory 
activities  following  the  use  of  small  quantities  of  alcohol 
opens  up  a  new  field  of  psychological  study.  A  study 
of  the  normal  man  shows  great  variations  of  a  similar 
character,  due  to  causes  that  may  or  may  not  be  traced. 


PATHOLOGY  OF  INEBRIETY.  183 

In  the  pathological  study  there  is  always  a  condition 
of  heredity  and  favorable  organic  states  to  be  consid- 
ered. Degenerations  from  the  slightest  exciting  causes 
are  more  likely  to  occur  in  some  organs  than  in  others. 

Certain  surroundings  and  environments  and  conditions 
of  nutrition  have  distinct  pathological  effects  that  are  to 
be  recognized.  It  is  an  established  fact  that  alcohol  has 
a  specific  depressing  action  on  the  psychic  brain,  or  that 
part  which  is  termed  character  or  consciousness  of  right 
and  wrong,  duty  and  obligation.  The  explanation  is  that 
this  being  the  last  formed  in  the  growth  of  the  brain 
is  the  first  to  suffer  and  deteriorate.  The  modern  patholo- 
gist, with  the  new  methods  of  staining  and  high  power 
microscopes,  finds  a  great  variety,  but  general  uniformity 
of  degenerative  changes. 

The  psychopathologist,  with  instruments  of  precision, 
measuring  the  functional  and  organic  activities  of  the 
body  finds  a  similar  uniform  palsy  and  depression. 

The  chemicopathologist  concludes  that  the  complexity 
of  the  toxins  of  alcohol  and  other  toxins  growing  out  of 
it  produce  a  distinct  change,  which  is  traceable,  and  that 
may  be  general  or  local  in  different  parts  of  the  body. 

The  anaesthesias  following  the  action  of  various  ethers 
of  alcohol  on  different  parts  of  the  body  show  very  re- 
markable changes  that  are  scarcely  yet  known. 

An  attempt  to  mark  out  an  exact  pathology  common 
to  all  persons  who  use  spirits,  presents  many  difficulties. 
One  author  of  large  experience  asserts  that  sclerosis  is 
not  a  common  sequela  from  drinking  spirits ;  another  that 
heart  changes  do  not  follow  uniformly. 

Their  observations,  of  course,  are  limited,  not  in  the 
number  of  persons  examined,  but  the  narrowness  of  the 
view  taken.  They  fail  to  realize  that  alcohol,  like  syph- 
ilis, has  a  peculiar  variable  virulent  action  on  different 


INEBRIETY. 


parts  of  the  body,  leaving  other  parts  more  or  less  in- 
tact ;  also,  they  fail  to  recognize  the  vast  field  of  suscep- 
tibility and  immunity  to  these  various  poisons,  and  the 
resisting  powers  of  the  body. 

One  fact  is  also  not  recognized,  that  the  use  of  alcohol, 
either  in  large  or  small  doses,  has  a  peculiar  cumulative 
action,  both  general  and  local,  and  this  may  be  over- 
looked and  ascribed  to  other  causes.  It  is  evident  from 
the  various  studies  that  alcohol  in  the  body  is  a  tissue  in 
poison,  both  eroding  and  corroding,  and  that  its  effects 
are  ordinarily  uniform  and  discernible. 

The  structural  pathologist  who  decides  on  the  absence 
of  any  observable  lesion  that  no  disease  is  present,  is 
greatly  mistaken.  To  assume  that  no  disease  exists,  that 
cannot  be  discovered  by  the  present  methods,  is  equally 
faulty. 

Many  writers  have  concluded  from  this  point  of  view 
that  inebriety  has  no  pathology,  but  is  a  condition  of 
morals  and  weakness.  Functional  pathology  is  as  evi- 
dent and  clearly  defined  as  that  of  structural,  and  must 
be  recognized  in  all  studies  of  pathology. 

The  disorders  preceding,  and  associated  with,  periodic 
paroxysms  for  drink  and  drugs,  must  of  necessity  date 
from  some  specific  change.  The  development  of  an  al- 
coholic craze  or  obsession  must  have  a  pathological  cause 
or  causes,  and  it  is  evident  that  to  this  are  added  the 
additional  corroding  influences  of  alcohol. 

The  later  researches  on  arterial  tension  and  obscure 
exaltations  and  depressions  show  the  same  fact.  A  great 
variety  of  very  startling  questions,  yet  to  be  answered, 
suggest  themselves.  One,  why  alcohol  should  be  used  for  a 
long  period  of  time  without  producing  more  serious  and 
decided  pathological  changes.  Why  persons  who  use 
alcohol  should  suffer  and  die  from  germs  or  other  diseases 


PATHOLOGY  OF  INEBRIETY.  185 

in  which  peculiar  symptoms  appear;  why  the  brain 
and  nervous  system  retains  most  of  its  vigor,  while  the 
body  would  suffer  acutely,  and  why  the  brain  and  nervous 
system  should  succumb  at  the  slightest  exposure. 

These  and  many  other  problems  make  the  pathology 
of  inebriety  a  great  dark  continent  in  which  only  a  little 
exploration  has  been  made. 


CHAPTER  XVIII. 
DIAGNOSIS  OF  INEBRIETY. 

Synopsis. —  Diagnosis  not  a  simple  matter.  Inebriates  have  a 
mania  to  conceal  and  cover  up  the  causes.  They  rarely  realize 
their  real  condition,  but  judge  from  their  feelings.  Symptoms 
of  neuritis  are  overlooked  and  the  alcoholic  cause  unrecognized. 
Moderate  drinkers  of  wine  and  beer,  ascribe  these  symptoms  to 
other  causes.  Midnight  drinkers  difficult  to  determine.  Persons 
who  claim  to  be  overworked  are  likely  to  be  spirit  drinkers. 
Opinions  of  authorities.  Diagnosis  of  persons  found  on  the  street, 
supposed  to  be  intoxicated.  Illustrative  examples.  Common 
errors.  Diagnosis  of  women  more  difficult.  Examples.  Delirium 
following  trauma.  Often  misjudged.  Delirium  from  fever  may 
come  from  alcohol.  Psychic  phase  of  intoxication  very  confusing. 
Complications  with  syphilis. 

It  would  appear  to  many  that  the  diagnosis  of  in- 
ebriety was  a  very  simple  matter.  The  common  symp- 
toms of  flushed  face,  alcoholic  breath  and  changed  man- 
ner, together  with  other  symptoms,  can  hardly  be  mistaken 
for  another  disease,  and  yet  there  are  stages  and  states 
of  inebriety  which  require  most  careful  study  to  dis- 
criminate. 

In  a  certain  number  of  inebriates  there  is  present  a 
literal  mania  to  conceal  and  cover  up  the  real  causes  of 
their  condition.  This  is  manifest  sometimes  in  unusual 
skill  and  cunning,  which  baffles  the  most  expert  diag- 
nostician. Elsewhere  we  have  described  the  midnight 
drinkers,  or  those  who  only  drink  in  conditions  of  great 
seclusion  away  from  home,  while  to  their  friends  and 
associates  they  appear  as  total  abstainers. 

Such  persons  frequently  appeal  to  medical  men  for  aid, 
and  appear  to  be  suffering  from  obscure  conditions  of 
debility,  mal-nutrition  and  exhaustion.  Often  business 
men  with  obscure  symptoms  supposed  to  come  from  over- 
work are  treated  with  great  minuteness,  when  in  reality 

the  real  cause  is  some  form  of  spirits. 
186 


DIAGNOSIS  OF  INEBRIETY.  187 

Examples  showing  this  difficulty  are  as  follows:  A 
clergyman  apparently  anasmic  suffered  from  insomnia,  and 
with  so-called  rheumatic  pains  in  the  lower  extremities 
made  the  rounds  of  eminent  physicians,  and  was  treated 
for  neuritis,  disorder  of  the  liver  and  other  ailments. 

All  means  seemed  to  fail  until  through  an  accident 
of  a  broken  leg  he  was  obliged  to  remain  two  months  in  a 
mountain  village.  His  improvement  was  astonishing.  On 
resuming  his  regular  work  he  became  ill  again,  went 
abroad  and  consulted  eminent  physicians.  Finally  he 
died  suddenly  in  a  country  village,  where  he  had  gone 
for  his  health. 

Then  it  was  ascertained  that  his  illness  was  due  to  his 
secret  use  of  spirits  and  the  slow  profound  poisoning, 
which  was  covered  up  by  most  unusual  efforts. 

Active  business  men  frequently  come  under  medical 
care  complaining  of  stiffness  and  wandering  pains  in  the 
feet  and  legs,  with  disturbed  digestion,  and  many  most 
complex  symptoms,  which  are  diagnosed  as  rheumatism, 
malaria  or  influenza. 

These  symptoms  increase  and  are  accompanied  with 
mental  irritation,  fatigue,  general  debility.  Often  med- 
ical men  prescribe  alcohol  in  some  form  as  a  tonic,  or 
the  patient  uses  proprietary  drugs  containing  spirits. 
This  may  go  on  a  long  time  before  the  first  cause,  spirits, 
is  recognized.  Opium  may  be  given,  and  the  patient  will 
apparently  become  addicted  and  the  real  cause  never  be 
recognized. 

Men  and  women  living  in  centers  of  excitement  and 
subjected  to  great  emotional  strains,  who  complain  of  ex- 
haustion and  exhibit  a  variety  of  obscure  symptoms  that 
seem  unlike  any  known  disease,  should  be  regarded  with 
suspicion  and  an  alcoholic  origin  of  their  difficulties 
sought  for. 


188  INEBRIETY. 

Persons  who  use  wine  at  meals  and  insist  that  they  are 
temperate  should  be  suspected  of  spirit  poisoning  when 
they  complain  of  neurotic  and  obscure  nutritive  disturb- 
ances. 

An  accurate  diagnosis  is  often  a  matter  of  considerable 
importance,  and  is  determined  by  inference  in  a  large 
measure,  particularly  in  college  graduates  and  young 
men  about  to  enter  business  or  professional  life,  who  com- 
plain of  rheumatic  pains,  general  obscure  exhausted 
states,  with  a  feeble,  irritable  heart  and  symptoms  that 
are  not  clear  or  defined. 

Anxious  parents  and  friends,  who  are  about  to  assist 
them  to  become  settled,  call  in  the  medical  man,  and  the 
diagnosis  is  exhaustion  from  overstudy  and  some  very 
vague  causes. 

The  advice  is  travel  and  rest.  If  the  travel  is  in 
Europe,  the  symptoms  increase,  and  the  case  becomes  more 
puzzling.  Then  it  appears  that  spirits  in  some  form 
have  been  used  and  their  condition  is  one  of  alcoholic 
toxaemia. 

Invalid  college  graduates  who  have  used  a  great  deal 
of  money  during  their  college  life  and  whose  conduct 
and  habits  have  been  bordering  on  the  realm  of  extrav- 
agance, are  always  to  be  regarded  with  suspicion,  and 
their  symptoms  of  disease  as  possible  indications  of  toxic 
poisonings. 

Many  men  in  early  life  have  drunk  to  excess  and 
then  became  abstainers  and  entered  upon  the  active  du- 
ties of  business  or  professional  life,  and  after  a  long 
period  of  temperate  living  suddenly  become  invalids.  The 
obscure  symptoms  and  the  absence  of  any  special  cause 
should  suggest  the  use  of  spirits  and  proprietary  drugs 
containing  spirits  as  the  active,  exciting  cause. 

A  noted  man  committed  suicide  and  his  friends  believed 
it  to  be  the  result  of  overwork  and  excessive  study.  In 


DIAGNOSIS  OF  INEBRIETY.  189 

reality  he  was  a  spirit  drinker  in  early  college  life,  and 
later  this  was  concealed,  but  it  continued  with  increasing 
intensity  until  his  final  collapse.  His  family  physician 
had  failed  to  discover  the  real  causes.  Many  persons  are 
sent  to  private  sanitoriums  for  complex  forms  of  mental  and 
nervous  diseases  that  are  specifically  due  to  spirit-taking. 

This  fact  is  discovered  in  their  rapid  improvement  when 
placed  in  surroundings  where  the  opportunities  for  se- 
curing spirits  are  difficult.  Persons  are  often  sent  to 
insane  asylums  suffering  from  mania,  insomnia  and  de- 
lirium that  have  never  Been  traced  to  any  particular 
causes. 

The  confinement  and  change  of  surroundings  in  the 
hospital  is  followed  by  a  rapid  improvement.  Sometimes 
the  real  cause  of  spirits  is  determined,  in  others  it  is  con- 
cealed, and  the  hospital  authorities  consider  recovery  due 
to  the  hygienic  conditions  and  change,  and  not  to  the 
removal  of  alcohol. 

In  criminal  investigations,  sudden  impulses  to  commit 
crime  or  do  overt  acts,  foreign  to  all  previous  conduct, 
have  been  traced  to  the  secret  use  of  spirits.  Often 
traveling  men,  speculators  and  active  brain  workers  ex- 
hibit startling  symptoms  of  mental  derangement,  de- 
veloping either  criminal  tendencies  or  displaying  cred- 
ulous stupidity,  and  the  causes  are  unknown  and  untrace- 
able.  They  are  not  known  as  drinking  men,  and  often 
claim  to  be  total  abstainers,  yet  after  a  time  the  use  of 
some  form  of  alcohol  appears  to  be  the  source  of  their 
trouble. 

The  late  Dr.  Kcrr  affirmed,  as  the  result  of  a  long 
experience,  that  obscure  and  unusual  neurotic  and  nutri- 
tive troubles,  marked  by  unusual  conduct,  should  always 
suggest  an  alcoholic  origin;  and  if  syphilis  could  be  elim- 
inated, the  use  of  alcohol  in  some  form  would  be  found 
as  an  active  cause. 


190  INEBRIETY. 

Many  very  prominent  neurologists  of  this  country  have 
asserted  that  quite  a  large  proportion  of  neurotic  and 
psychopathic  troubles  were  traceable  to  injuries  from 
spirits,  and  that  no  diagnosis  was  of  any  value  that  did 
not  consider  the  possibility  of  alcoholic  poisoning  as  a 
factor  in  the  production  of  such  diseases. 

There  is  a  prevalent  theory  among  many  classes  that 
alcohol  in  moderation  or  in  small  quantities  can  be  taken 
indefinitely  without  any  harmful  effects.  This  is  not 
sustained  by  scientific  investigation,  which  shows  that  al- 
cohol is  cumulative  in  its  degenerative  influences,  and  in 
some  persons  this  cumulative  action  is  very  pronounced, 
although  not  always  traceable,  except  by  very  accurate 
studies. 

Instances  like  the  following  are  common.  Persons 
pursuing  a  healthy,  uniform,  regular  course  of  life,  who 
use  beer  or  wine  at  meals,  and  on  no  other  occasions, 
suddenly  become  invalids,  and  there  is  no  ostensible  cause 
for  it.  Not  unfrcquently  such  persons  apparently  break 
down  and  develop  very  unusual  conduct  and  changes,  ap- 
parently resulting  from  business  or  social  losses.  Their 
use  of  beer  and  spirits  continues  at  the  table,  and  no  one 
suggests  the  cumulative  action  of  alcohol  in  producing 
toxic  poisonings. 

Examples  are  common  of  men  who  suddenly  contract 
pneumonia  that  is  fatal,  or  suffer  from  cerebral  hemor- 
rhage, or  develop  some  acute  organic  trouble  of  the  liver. 
Their  previous  life  has  been  comparatively  healthy,  only 
wine  and  beer  has  been  taken  at  the  table  in  moderation. 

The  physician  recognizes  the  unusual  intensity  of  the 
degenerations  and  the  verv  feeble  resisting  power  of 
nature  and  the  remarkable  weakness  and  protracted  con- 
valescence. The  cumulative  action  of  alcohol  is  mani- 
fest in  this.  Very  interesting  cases  are  constantly  coming 
into  prominence,  bringing  out  this  fact. 


DIAGNOSIS  OF  INEBRIETY.  191 

Not  unfrequently  patients  are  found  to  be  using  pro- 
prietary drugs,  tincture  of  ginger,  cinchona  and  other 
medicines,  both  regular  and  irregular.  The  spirits  con- 
tained in  them  are  the  active  causes,  but  do  not  attract 
attention.  The  diagnosis  at  home  by  the  family  physi- 
cian can  often  be  made  with  great  certainty  where  all  the 
habits  and  conditions  of  daily  life  can  be  studied. 

The  diagnosis  of  persons  found  stupid  on  the  streets 
with  or  without  an  alcoholic  breath,  often  present  most 
obscure  questions.  Many  instances  of  persons  becoming 
suddenly  dizzy  and  faint  on  the  street  who  have  taken  a 
glass  of  spirits  for  relief  and  later  fallen  down  uncon- 
scious, have  been  diagnosed  by  policemen  as  intoxicated, 
simply  from  an  alcohol  odor. 

Such  persons  taken  to  the  station-house  have  died,  and 
serious  questions  have  arisen  in  which  the  officiousness  of 
the  policeman  in  deciding  on  the  nature  of  the  case  has 
been  condemned. 

Heat  or  sun-stroke  of  persons  on  the  street  has  pro- 
duced conditions  for  which  spirits  were  given  as  a  stim- 
ulant, and  the  same  error  of  diagnosis  has  been  made. 
Dr.  Mason  has  studied  this  question  and  presented  in 
some  recent  papers,  many  very  startling  examples  of  error 
of  diagnosis,  resulting  in  death.* 

The  one  fact  should  always  be  considered,  viz. :  that 
the  man  found  unconscious  on  the  street  may  be  suffering 
from  a  hemorrhage,  and  a  glass  of  spirits  as  a  stimulant 
to  rouse  him  up  is  a  most  fatal  remedy.  The  increased 
heart's  action  widens  the  rupture  and  intensifies  the  hem- 
orrhage, making  it  fatal.  A  physician  called  suddenly 
to  treat  a  case  found  unconscious  should  never  permit 
spirits  to  be  used. 

No  diagnosis  of  the  conditions  can  be  accurate  which  is 
based  on  the  odor  of  spirits,  or  even  on  the  dilated  or 


•  See    paper    in    Virginia    MerUcal    Monthly,    December    22,    1910,    by    Dr. 
Mason    on    Diagnosis    of    Alcoholic   Coma. 


INEBRIETY. 


contracted  pupils.  Persons  previously  temperate,  for 
some  sudden  emergency,  may  be  given  spirits  and  the 
effects  may  be  so  unusual  and  peculiar  as  to  suggest  in- 
ebriety and  alcoholism,  which  is  an  error. 

Psychical  changes  of  character  and  conduct  that  are 
sudden,  pronounced  and  prominent  should  suggest  an 
alcoholic  origin,  no  matter  what  the  previous  character 
of  the  patient  may  be.  A  remarkable  case  was  of  a 
physician,  for  twenty  years  occupying  a  very  responsible 
position  and  having  an  unblemished  reputation  in  his 
community,  who  suddenly  developed  criminal  practices 
that  sent  him  to  prison  under  most  distressing  circum- 
stances. 

Then  it  finally  became  known  that  he  had  used  spirits 
in  small  quantities  daily,  and  that  their  cumulative  action 
suddenly  developed  into  palsy  of  the  higher  brain  cen- 
ters. This  is  a  confirmation  of  the  fact  presented  in 
another  chapter,  namely,  that  the  use  of  alcohol,  either 
in  excess  or  moderation,  seems  to  fall  most  heavily  on  the 
ethical  brain,  destroying  the  consciousness  of  right  and 
wrong,  and  the  conception  of  duty  and  obligation. 

The  diagnosis  of  inebriety  in  women  is  more  difficult 
because  of  the  greater  complexity  of  causes,  and  their 
ability  to  conceal  them.  The  use  of  spirits  at  the  men- 
strual period  or  at  the  menopause  is  more  or  less  common, 
and  may  become  the  starting-point  of  very  complex  neu- 
roses and  disorders  that  will  baffle  the  skill  of  specialists. 

Many  very  striking  cases  occur  which  are  subjects  of 
great  controversy  and  confusion  of  opinion.  It  may  be 
stated  that  the  sudden  appearance  of  unusual  neurotic 
symptoms  should  suggest  a  toxic  poisoning.  Slight 
traumata,  shocks  and  common  social  reverses  and  trou- 
bles, followed  by  unusually  severe  nervous  symptoms, 
may  have  the  same  origin.  Delirium  from  fever,  of  un- 
usual proportion  and  intensity,  has  been  traced  in  many 
instances  to  the  alcohol  given  as  a  remedy. 


DIAGNOSIS  OF  INEBRIETY.  193 

The  subsidence  of  the  delirium  on  the  removal  of  the 
alcohol  shows  the  connection  between  the  two.  A  man 
of  wealth  suffered  from  intense  fatigue  and  depression 
following  a  mild  sun-stroke.  His  physician  gave  him  a 
preparation  of  brandy  and  milk. 

The  weakness  of  the  heart  seemed  to  call  for  increased 
doses,  and  the  delirium  which  followed  was  diagnosed  as 
meningitis.  A  number  of  physicians  were  called  in  con- 
sultation, and  very  active  measures  were  ordered,  the 
spirits  being  continued  to  sustain  the  heart. 

The  delirium  grew  more  intense  and  also  the  exhaus- 
tion. The  patient  was  taken  to  his  country  home,  and 
by  some  accident  the  supply  of  spirits  was  cut  off  for 
twenty-four  hours.  The  improvement  was  so  marked  that 
the  nurse  continued  the  withdrawal,  and  the  recovery  was 
very  prompt.  No  one  had  diagnosed  the  influence  of 
alcohol  in  the  production  of  the  delirium. 

In  old  men  the  possibility  of  spirits  in  some  form  in- 
creasing and  complicating  the  conditions  should  always 
come  into  the  problem.  The  idiosyncrasies  of  persons, 
either  in  great  susceptibility  to  the  toxic  action  of  alcohol, 
or  in  its  local  effect  on  particular  organs,  should  always 
be  considered  in  the  diagnosis.  Elsewhere  we  hav2  re- 
ferred to  symptoms  of  intoxication  which  are  largely 
mental,  and  are  not  due  to  any  form  of  alcohol  but  to 
some  defective  condition  produced  by  alcohol  in  the  past. 

The  nervous  system  seems  to  reproduce  the  toxic  con- 
dition which  was  impressed  upon  it  from  alcohol  by  the 
application  of  some  unknown  exciting  causes.  In  making 
a  diagnosis  of  the  presence  of  alcohol,  this  condition 
should  be  considered  as  possible. 

Where  syphilis  has  existed  greater  complexities  of 
symptoms  may  obscure  the  real  causes,  but  an  active  mer- 
curial treatment  will  frequently  clear  up  this  obscurity. 
In  the  ordinary  diagnosis  of  inebriety  a  careful  study  of 


194*  INEBRIETY". 

the  previous  conduct  and  habits  of  the  patient,  and  a 
comparison  of  that  and  the  present,  will  furnish  unmis- 
takable signs. 

It  is  safe  to  assume  that  any  use  of  spirits  may  pro- 
duce results  entirely  unexpected,  and  out  of  all  propor- 
tion to  the  supposed  causes.  It  also  should  be  remem- 
bered that  alcohol  is  cumulative  in  its  action,  and  that 
some  persons  are  peculiarly  sensitive  to  its  degenerative 
action. 

A  study  of  heredity,  occupation  and  surroundings  will 
often  suggest  possibilities  of  the  use  of  alcohol  which  can 
be  asserted  with  as  much  certainty  as  practical  knowledge. 
The  fact  that  alcohol  deranges  the  senses  and  dimin- 
ishes the  reasoning  power  and  lowers  the  capacity  to 
recognize  duty  and  relation  to  others,  is  always  to  be 
considered  where  these  facts  are  prominent.  In  all  the 
varied  neuroses  and  psychoses  occurring  after  middle  life 
this  factor  should  be  recognized  as  possible,  and  one 
that  must  be  eliminated  in  an  accurate  diagnosis. 

Delirium  and  delusional  conditions  often  present  prob- 
lems that  suggest  alcohol  as  an  exciting  cause,  thus  the 
delusion  of  infidelity  on  the  part  of  the  wife  or  husband 
is  so  commonly  noted  in  secret  and  open  drinkers  as  to  be 
recognized  as  a  diagnostic  symptom. 

Delirium  of  grandeur  and  strength  and  extraordinary 
confidence  in  ability  to  accomplish  the  impossible  is  an- 
other symptom  with  the  same  significance.  As  stated  in 
previous  chapters,  the  sudden  use  of  alcohol  often  covers 
up  the  symptoms  and  draws  attention  to  this  alone,  and 
this  may  obscure  the  real  conditions  as  in  paresis,  where 
alcoholic  and  sexual  excess  are  only  symptoms. 

Thus  the  problem  of  diagnosis  widens  and  becomes 
more  complex,  and  often  can  be  only  approximately  made 
from  a  very  careful  study  of  all  the  symptoms. 


CHAPTER  XIX. 
PROGNOSIS  OF  INEBRIETY. 

Synopsis. —  Differences  of  opinion  about  curability.  Confusion 
of  opinions.  Great  variety  of  means  used.  The  general  principles 
of  treatment.  Questions  of  prognosis.  Compared  to  that  of 
other  diseases,  depends  on  heredity  and  predisposition.  Exhaus- 
tion and  debility  govern  the  prognosis.  The  prognosis  bad  when 
spirits  are  used  in  infancy.  Also  bad  in  beer  drinkers.  The  peri- 
odic drinker  most  hopeful.  The  nerve  storms  point  to  some  active 
causes.  Delusions  of  exaltation  of  doubtful  prognosis.  Prog- 
nosis bad  when  other  drugs  follow  the  use  of  spirits.  Persona 
may  relapse  and  drink  again  after  years  of  abstinence.  Con- 
dition of  the  arteries  important  guide  in  the  prognosis.  Reasons 
for  this.  Changes  in  the  circulation  of  the  brain  create  desire 
for  drink.  Syphilis  a  complicating  cause.  About  one-third  of 
all  cases  are  curable.  The  prognosis  in  these  cases  is  fair.  It 
depends  largely  on  the  conditions  of  the  person  and  his  sur- 
roundings. 

Curiously  enough  inebriates  are  very  emphatic  and 
prominent  in  determining  the  prognosis  of  their  individ- 
ual cases,  and  physicians  are  often  influenced  by  their 
positive  statements  of  ability  to  recover. 

This  side  of  the  subject  makes  prominent  the  moral 
side,  and  a  voluminous  literature  has  appeared,  giving 
reasons  and  explanations  why  the  victim  does  not  fulfill 
his  asserted  predictions  of  ability  to  stop,  and  why  he 
does  not  recover  from  the  use  of  spirits.  The  hopeful- 
ness of  the  inebriate  is  characteristic,  and  becomes  an 
optimistic  delusion  that  often  increases  with  the  degen- 
eration of  the  person.  The  more  pronounced  his  faith  in 
his  ability  to  stop  and  confidence  in  his  power  of  con- 
trol, the  weaker  he  is. 

Often  this  delusional  exaltation  is  an  indication  of 
paretic  changes  that  develop  after  a  time.  The  con- 
tinued failure  to  abstain,  extending  over  years,  makes  no 
impression  on  his  judgment.  The  same  assertions  of  his 
ability  to  stop  are  made  with  the  same  confidence  as  before. 
7  195 


196  INEBEEETY. 

Notwithstanding  these  delusions,  the  general  prognosis 
of  inebriety  is  very  hopeful.  Many  persons,  with  or 
without  any  special  treatment,  recover.  It  is  asserted 
that  the  disease  marked  by  drink  excesses  is  limited  to  a 
period  of  not  more  than  fifteen  years.  Thus,  a  person 
who  begins  to  drink  to  intoxication  will  die  within  fif- 
teen years. 

Of  course,  it  is  difficult  to  place  any  limit  to  the  or- 
ganic duration,  because  the  causes  are  so  complex  and 
varied.  One  fact  is  established  from  a  great  variety  of 
studies,  viz. :  that  the  craze  for  alcohol  at  times  dies  out 
of  itself  from  causes  unknown. 

Observation  shows  that  a  certain  number  of  patients 
who  are  confirmed  inebriates,  using  spirits  to  excess,  either 
continuously  or  at  long  intervals,  suddenly  abstain  and 
remain  temperate  ever  after.  The  explanation  of  this 
sudden  giving  up  of  the  use  of  spirits  is  usually  ascribed 
to  the  last  means  used. 

This  may  have  been  a  pledge,  a  prayer  or  conversion, 
or  a  mere  assertion  of  the  will,  not  to  drink  any  more. 
These  means  were  used  many  times  before,  and  failed,  but 
now  they  succeed.  Some  religious  men  assert  that  the 
former  failures  of  inebriates  to  give  up  the  addiction  of 
spirits  was  due  to  errors  in  their  conversion ;  that  only 
at  the  last  moment,  when  the  conversion  was  real  and 
true,  did  restoration  follow. 

Other  persons  sign  the  pledge  under  precisely  the  same 
circumstances  which  they  have  done  many  times  before 
and  keep  it.  The  question  is  asked  why  this  did  not 
happen  before,  and  a  great  variety  of  explanations  are 
offered. 

Thus,  one  man  has  signed  the  pledge  ninety-nine  times, 
or  professed  conversion  ninety-nine  times,  and  failed  on 
every  occasion.  Then  finally  he  stopped  and  the  last 


PROGNOSIS  OF  INEBRIETY.  197 

conversion  and  signing  of  the  pledge  was  considered  the 
real  cause  of  his  success. 

Many  curious  incidents  and  most  unusual  events,  or  the 
use  of  drugs  are  given  as  reasons  for  the  final  cure  and 
restoration.  Tansy  tea  and  other  bitter,  nauseating 
drugs,  followed  by  a  disgust  for  spirits,  is  supposed  to 
have  caused  it.  The  fact  is  overlooked  that  many  of 
these  agents  have  been  used  before  without  any  par- 
ticular effect. 

Patent  medicines  that  are  supposed  to  have  some  mar- 
velous action  refer  back  to  such  instances,  and  the  fact 
that  they  were  followed  by  total  abstinence  is  considered 
evidence  of  their  power. 

The  real  fact  is  not  often  recognized,  that  in  a  large 
number  of  cases  there  is  a  tendency  of  the  drink  craze 
to  die  out  or  disappear  with  or  without  any  special  causes. 
The  craving  for  relief,  for  which  alcohol  is  used,  passes 
away,  and  is  followed  by  great  disgust  and  aversion  to 
spirits. 

The  question  whether  this  will  return  again  is  unknown, 
but  it  is  evident  that  medicinal  means  and  restorative  meas- 
ures may  so  far  build  up  the  organism  that  the  drink 
impulse  will  never  return.  Observations  of  the  temper- 
ance reform  movements  and  studies  of  the  so-called  cure 
cases,  show  that  the  very  means  used  preceding  the  final 
cure  were  not  new,  but  had  been  tried  many  times  before. 

Of  the  five  million  persons  who  signed  the  pledge  of 
total  abstinence  in  the  Washingtonian  Movement  from 
1840  to  1845  a  certain  unknown  number  remained  total 
abstainers  the  remainder  of  their  lives.  In  the  same  way 
every  great  religious  and  temperance  revival  work  is 
marked  by  the  restoration  of  an  uncertain  number  of  in- 
ebriates, who  never  relapse  again. 

It  is  very  evident  that  the  same  general  causes  do  not 


198  INEBRIETY. 

produce  the  same  effects  in  all  persons,  and  that  restora- 
tion and  breaking  up  of  the  drink  craze  depends  on  some 
unknown  condition  or  change  in  the  brain  centers.  Acting 
on  this  general  fact,  it  is  clear  that  remedies  addressed 
to  the  physical  and  psychical,  and  to  the  development  of 
a  more  perfect  organic  functional  activity  will  predispose 
to  this  revolution  or  dying  out  of  the  drink  craze  and 
favor  it  more  positively  than  any  other  means. 

The  prognosis,  therefore,  is  far  more  hopeful  where 
the  best  physical  and  medical  appliances  known  are 
used,  and  where  every  psychical  and  physical  remedy  can 
be  applied  to  build  up  and  restore  the  disordered  condi- 
tions. Unexpected  recoveries  are  constantly  taking  place 
in  conditions  that  are  unfavorable,  and  certainly  can  not 
be  explained  from  any  present  knowledge. 

Thus  a  person  who  has  used  spirits  for  over  half  a 
lifetime  and  has  become  pronouncedly  chronic,  suddenly 
stops  and  becomes  an  abstainer  under  the  most  adverse 
conditions  and  from  causes  entirely  unexplainable. 

Another  class  of  cases  seems  to  date  recovery  from  some 
accident  or  injury  or  shock,  or  powerful  mental  emotion. 
Cases  are  noted  where  a  blow  on  the  head,  profound  shocks 
from  disappointment,  fright,  or  any  powerful  emotions 
is  followed  by  a  disappearance  of  the  drink  craze  for 
ever  after. 

The  following  are  illustrative  instances.  An  army 
officer  who  had  drunk  to  excess  for  over  thirty  years  was 
reprimanded  for  some  failure  of  duty.  He  stopped  drink- 
ing at  once,  and  continued  until  death  a  sober,  tenfperate 
man. 

A  man  with  the  history  of  a  police  court  repeater, 
who  had  been  arrested  several  hundred  times  for  drunken- 
ness, suddenly  begged  for  permission  to  sign  the  pledge, 
and  for  many  years  afterwards  remained  thoroughly  tem- 
perate. 


PROGNOSIS  OF  INEBRIETY.  199 

Another  man,  with  a  similar  history,  after  being  treated 
for  jaundice  in  the  hospital  became  a  total  abstainer.  A 
quarrelsome  inebriate,  who  was  known  to  have  a  great 
fear  of  drowning,  while  stupid  was  tied  by  a  rope  and 
thrown  into  a  river.  The  excitement  and  shock  of  rescu- 
ing him  was  followed  by  perfect  immunity  from  all  use 
of  spirits  for  the  rest  of  his  life. 

An  incident  worth  recording,  because  the  parties  occu- 
pied prominent  places  in  society,  was  of  a  physician  who, 
while  visiting  a  patient  found  her  half-intoxicated  hus- 
band abusing  her  for  the  purpose  of  getting  some  money. 
The  physician  gave  the  drunken  man  a  severe  pounding, 
breaking  his  leg  and  making  him  unconscious.  The  man 
recovered  and  never  drank  again. 

These  are  only  a  few  of  examples  that  are  more  or 
less  common,  showing  the  effects  of  violent  emotion,  im- 
pressing the  organism  and  producing  some  changes  that 
culminate  in  the  disappearance  of  the  drink  craze  and 
aversion  for  alcohol  ever  after. 

The  inference  must  not  be  made  that  recovery  always 
follows  from  these  traumata  and  shocks,  but,  on  the  con- 
trary, similar  injuries  have  been  followed  by  a  great 
increase  in  the  drink  craze,  and  often  such  injuries  have 
been  exciting  causes. 

Inebriety,  associated  with  trauma,  is  a  mysterious  field 
of  cause  and  effect,  with  a  very  uncertain  prognosis.  In 
a  general  way,  where  the  causes  of  the  drink  craze  are 
distinct  and  readily  explained,  the  prognosis  is  fair,  be- 
cause the  remedies  can  be  addressed  more  or  less  directly 
to  the  removal  of  the  causes. 

The  prognosis  in  inherited  cases  is  uncertain,  unless 
the  surroundings  and  conditions  can  be  controlled,  and 
where  mal-nutrition  and  mental  contagion  are  present,  the 
application  of  remedies  give  great  promise  of  relief. 
Where  the  drink  craze  develops  a  distinct  psychosis,  with 


200  INEBRIETY. 

well  marked  symptoms  of  insanity,  great  uncertainty 
exists. 

The  most  hopeful  cases  are  those  where  inebriety  ap- 
pears to  be  the  direct  result  of  overwork,  mental  strain, 
nerve  exhaustion  and  neglect  of  the  surroundings.  Quacks 
assert  dogmatically  that  all  persons  are  curable  if  they 
use  the  proper  remedies,  which  they,  only,  possess. 

The  moralists  are  equally  certain  that  they  possess 
absolute  curative  measures  to  overcome  the  drink  impulse. 
The  general  practitioner  notes  that  many  chronic  cases 
recover  both  by  quack  methods,  the  appeal  of  moralists 
and  without  any  special  means  or  remedies.  He  also 
observes  examples  of  cases  whose  cures  are  attributed  to 
a  great  variety  of  the  most  diverse  means  and  measures. 

It  is  very  evident  from  this  conflicting  clinical  experi- 
ence that  most  profound  ignorance  exists  of  the  real 
causes,  as  well  as  the  nature  and  progress  of  the  disease. 
The  specialist,  who  makes  a  more  exact  study,  finds  more 
examples  of  curability  from  the  removal  of  the  exciting 
causes,  and  is  able  to  make  a  prognosis  based  on  certain 
conditions  that  are  more  or  less  exact. 

There  are  a  certain  number  of  persons  in  which  spirits 
are  the  pronounced  exciting  causes  more  so  than  any 
other  factors.  When  these  are  removed  the  future  is 
good.  In  other  cases,  where  the  constitutional  defects  and 
inherited  weaknesses  are  manifest  in  the  symptom  of 
alcohol  used  for  relief,  the  prognosis  will  be  less  favor- 
able. 

If  the  early  life  of  the  patient  has  been  one  of  good 
physical  and  mental  training,  there  is  a  basis  for  de- 
velopment and  future  restoration  that  is  very  favorable. 
Where  precosity  and  over-development  have  marked  the 
first  part  of  life,  the  probability  that  the  drink  craze  is 
only  a  symptom  of  the  profound  changes  and  exhaustion, 
makes  the  prognosis  doubtful.  Where  wine  and  spirits 


PROGNOSIS  OF  INEBRIETY.  201 

are  used  in  early  childhood,  either  as  a  beverage  or  medi- 
cine, there  would  naturally  be  a  very  low  resisting  power, 
and  predisposition  to  seek  relief  from  this  source  in  later 
life. 

The  early  use  of  beer  also  makes  the  prognosis  uncer- 
tain. In  periodic  drinkers  where  after  distinct  free  in- 
tervals the  drink  impulse  breaks  out  like  a  nerve  storm 
and  is  limited  to  a  certain  fixed  period,  the  prognosis  is 
better,  because  it  is  always  possible  to  discover  the  active 
and  predisposing  causes  and  neutralize  or  prevent  them. 

Temperance  reformers  who  are  periodic  drinkers,  show- 
ing extraordinary  activity  and  interest  to  help  others, 
belong  to  this  same  convulsive  class,  and  should  be  helped 
with  the  application  of  exact  means.  The  constant, 
steady  drinker  has  less  favorable  prognosis  than  the 
periodic. 

The  man  with  hyperconfidence  in  his  ability  to  stop 
is  always  prominent,  and,  on  general  principles,  should 
be  a  very  hopeful  case  if  this  delusion  is  not  of  a  paretic 
character.  The  patient  who  uses  narcotics,  smokes  tobacco, 
drinks  tea  and  coffee  and  eats  inordinately  has  not  a 
good  prognosis. 

The  prospects  of  taking  up  spirits  again  are  evident. 
The  toxasmic  conditions  from  which  he  is  suffering  predis- 
poses to  this. 

Among  the  great  variety  of  conditions  controlling  the 
prognosis,  are  unhealthy  living,  bad  habits,  bad  sur- 
roundings and  general  unhygienic  lives.  Unless  these 
are  corrected,  there  is  little  hope  for  future  change. 

Physiologically,  the  patient  with  high  arterial  tension 
and  derangement  of  the  nutrition  has  a  doubtful  future, 
unless  alcohol  is  withdrawn  immediately.  Specific  poison- 
ing is  another  complication  making  the  neurosis  more  or 
less  uncertain.  Slight  cerebral  hemorrhages  are  some- 
times followed  by  a  complete  cessation  of  the  drink  craze, 


202  INEBRIETY. 

and  local  palsies,  showing  organic  changes,  increase  the 
future  uncertainty  of  the  case. 

The  sudden  disappearance  of  the  drink  craze  if  fol- 
lowed by  a  radical  change  and  removal  of  the  general  and 
local  exciting  causes  is  very  hopeful,  but  unless  there  is  a 
decided  change  in  the  habits  of  life,  surroundings  and 
conditions  of  living  there  is  less  hope  of  the  permanent 
disappearance  of  the  drink  craze.  Long  continued  con- 
finement, as  in  a  hospital  or  jail,  unless  associated  with 
pronounced  physical  restoration  and  mental  growth  is  not 
hopeful. 

Many  persons  believe  that  the  inebriate  is  hopeless  and 
his  final  cure  is  doubtful,  but  this  is  contradicted  by 
experience.  The  drink  craze  or  drink  symptom  is  almost 
certain  to  disappear  from  the  application  of  exact  means 
and  measures.  While  the  organic  degenerations,  of  which 
this  is  a  symptom,  may  remain,  this  particular  phase 
passes  away. 

The  prognosis  may,  therefore,  be  considered  as  promis- 
ing as  that  of  many  other  diseases,  and  it  may  be  said 
that  there  is  a  tendency  to  recover,  particularly  upon  the 
removal  of  the  exciting  causes. 

This  gives  the  greatest  encouragement  for  increased 
scientific  care  and  study.  The  fact  should  not  be  over- 
looked that  a  large  proportion  of  all  inebriates  reach 
chronic  stages  before  they  come  under  treatment.  Hence 
the  difficulties  are  increased.  When  the  disease  is  recog- 
nized to  the  extent  that  the  patient  will  seek  medical  care 
from  the  family  physician  in  the  early  stages,  recovery 
will  be  the  rule,  and  not  the  exception,  and  the  prognosis 
should  be  very  hopeful  and  promising. 


CHAPTER  XX. 
DELIRIUM  TREMENS. 

Synopsis. —  A  distressing  condition.  Not  well  known,  or  care- 
fully studied.  A  new  type  or  form  noted.  Several  distinct  stages. 
All  leading  up  to  profound  delusions.  Many  of  the  cases  aborted. 
The  withdrawal  of  spirits  not  followed  by  increase  in  the  deli- 
rium. A  large  mental  element  to  be  considered.  Spirits  to  be 
withdrawn  according  to  this  condition.  A  study  of  the  physical 
conditions  explains  many  of  the  delusions.  Often  the  delusions 
are  concealed.  One  a  delusion  of  violent  language  in  which  the 
patient  does  not  utter  audible  sounds.  Disorientation  a  common 
symptom.  Delusions  having  reference  to  events  of  the  past  equally 
common.  These  are  preceded  by  nutrient  disturbances  and  tox- 
aemic  states.  Often  the  delusions  are  contagious  and  imitative. 
The  symptomology  very  complex  and  diversified.  Elimination  is 
the  most  essential  in  the  treatment.  Baths  of  all  sorts  called 
for.  Narcotics  dangerous.  Mortality  is  high  when  patients  are 
treated  with  narcotics.  Restraint  and  liberty  alternately  valuable. 
Quietness  and  rest.  Nutrition  should  be  limited,  except  in  special 
cases.  No  danger  of  collapse  from  want  of  food.  Excitement  to 
be  prevented.  Instances  of  psychical  treatment,  by  fear  and  shock. 
Opium  contra-indicated.  Wide  variations  in  the  mortality.  Il- 
lustrative instances.  Life  insurance  statistics.  Diseases  that  fol- 
low. After  effects  on  the  brain.  The  central  facts  to  be  ob- 
served in  the  treatment. 

Delirium  tremens  is  one  of  the  prominent  and  distress- 
ing conditions  which  follow  from  the  excessive  use  of 
spirits.  The  text-books  contain  various  descriptions  of 
what  is  called  alcoholic  delirium,  mania  a  potu,  and  other 
terms,  signifying  distinct  forms  of  insanity,  which  are 
due  to  the  excessive  use  of  spirits. 

The  old  term  delirium  tremens  was  marked  by  exces- 
sive muscular  agitation  and  delirium,  which  after  a  few 
days  subsided  with  or  without  any  special  treatment.  The 
modern  type  of  this  form  of  degeneration  from  spirits 
is  marked  by  greater  mental  symptoms  and  less  disturb- 
ance of  the  motor  activities. 

In  certain  cases  of  inebriety  there  can  often  be  traced 
many  distinct  stages  which  precede  the  outbreak  of  the 
delirium.  First  is  a  period  of  undue  excitement  and 

203 


204  INEBRIETY. 

anxiety  concerning  his  own  conduct  and  his  relations  to 
his  friends  and  surroundings. 

Hysteric  fears,  alternating  with  unusual  buoyancy 
and  confidence  in  his  ability  to  understand  and  regulate 
his  conduct  and  control  events  about  him.  This  may 
last  or  three  days. 

A  second  stage  begins  with  gastric  disturbances,  in- 
somnia and  periods  of  mental  exaltation  or  depression. 
The  desire  for  spirits  disappears  for  a  time  and  then 
returns  with  greater  intensity  than  before. 

Defects  of  sight  and  hearing  appear  with  muscular 
agitation  and  inability  to  remain  quiet,  and  a  continuous 
use  of  spirits  for  the  purpose  of  overcoming  this  con- 
dition. This  is  generally  a  short  stage. 

Then  a  third  period  begins  in  which  insomnia  is  in- 
tensified and  general  muscular  excitement  with  sense  de- 
ceptions fixed,  and  hallucinations  concerning  himself  and 
surroundings. 

In  this  period  there  is  a  half -conscious  recognition  of 
his  condition  and  a  struggle  to  overcome  it.  Finally  a 
fourth  stage  or  period  comes  on,  marked  by  great  fear 
and  suspicion,  with  delusional  reasoning,  sometimes  marked 
muscular  trembling;  in  others,  very  little  muscular  agi- 
tation, except  in  attempting  to  overcome  some  particular 
evil  that  is  threatening. 

Spirits  are  taken  as  a  medicine  and  there  seems  to  be 
no  craving  for  them,  but  only  for  their  possible  sedative 
effects.  Delusions  of  sight  and  hearing  with  insomnia 
are  common  symptoms,  and  point  at  once  to  the  inability 
to  co-ordinate  the  sense  impressions. 

Frequently  they  are  confined  to  the  night,  and  pass 
away  in  the  daytime.  The  withdrawal  of  spirits  and  a 
sharp  elimination  is  often  followed  by  the  disappearance 
of  the  delusions,  but  where  spirits  are  used  for  fear  of 


DELIRIUM  TREMENS.  205 

them,  they  may  be  controlled  temporarily,  but  always  re- 
turn with  great  intensity. 

Muscular  trembling  in  these  cases  is  due  to  fear  in 
many  instances  and  not  to  central  irritation.  At  times 
only  delirium  is  present.  At  others,  it  is  confined  en- 
tirely to  sense  delusions.  When  both  delirium  and  delu- 
sions are  present,  a  careful  study  of  the  physical  condi- 
tion of  the  patient  should  be  made.  Thus  gastritis, 
neuritis  and  any  particular  local  inflammation  will  be  very 
influential  in  the  mental  conditions. 

A  history  of  malaria  or  trauma  from  injury,  shocks 
or  the  sequela  of  fever  or  neglect  of  the  ordinary  hygienic 
conditions,  all  have  a  very  important  significance  in  the 
treatment. 

When  muscular  trembling  is  pronounced  from  the  be- 
ginning, local  irritations  of  the  cords  are  present.  Per- 
sons who,  after  excessive  use  of  spirits,  develop  sense  de- 
ceptions and  hallucinations  are  often  suffering  from 
toxarmic  poisonings.  Persons  who  have  used  spirits  con- 
tinuously for  a  long  time,  then  develop  deliriums  and 
delusions,  are  not  only  poisoned  but  suffering  from  some 
organic  change  and  irritation.  Persons  who  drink  peri- 
odically and  at  the  close  of  a  drink  paroxysm  become 
delusional,  are  no  doubt  suffering  from  both  cell  and 
nerve  poisoning. 

Very  curious  studies  have  been  made  of  the  exact  form 
of  delusions,  tracing  them  to  distinct  local  organic  de- 
rangements. Thus,  delusions  of  small  animals  such  as 
frocjs,  snakes  and  insects  crawling  over  the  face  and 
body,  are  often  due  to  congestion  of  the  retina,  and  dis- 
ordered conditions  of  the  pcriphcrial  nerves. 

When  largo  animals  assume  a  threatening  attitude, 
and  when  persons  with  weapons  try  to  do  him  injury, 
there  is  no  doubt  both  local  irritation  and  congestion  of 


206  INEBRIETY. 

the  nerve  centers,  and  an  almost  infinite  variety  of  de- 
lirium and  delusions  appear  in  different  persons,  some  of 
them  grotesque  and  humorous,  others  dangerous  and  ap- 
palling. 

All  hallucinations  in  which  the  person  hears  insulting 
words  and  holds  conversations  with  imaginary  persons 
are  dangerous,  because  concealed,  and  likely  any  moment 
to  materialize  into  violent  acts.  Delusions  of  persecution 
and  fear  of  injury  or  sudden  assaults  are  also  dangerous. 

The  profound  pallor  and  profuse  perspiration  point  to 
concealed  alarm  and  fear,  and  a  state  of  tension  that  may 
any  moment  concentrate  into  violent  acts.  It  is  prac- 
tically impossible  to  tabulate,  in  any  uniform  groups, 
these  various  delusional  states  and  mental  obsessions,  but 
their  physical  nature  and  causation  should  always  be 
studied  and  recognized  in  the  treatment. 

One  of  these  curious  conditions  is  the  delusion  that 
the  patient  is  uttering  the  most  violent  language,  and 
from  word  deafness  and  other  causes  he  utters  no  audible 
sounds.  Such  patients  look  about  in  astonishment  that 
the  violent  thoughts  passing  through  their  mind,  sup- 
posed to  be  spoken,  do  not  seem  to  attract  any  attention. 

In  one  instance,  a  man  in  a  delirious  state  apologized 
continuously  for  the  wild,  abusive  talk,  and  expressed 
great  sorrow,  saying  that  he  could  not  help  it  and  was 
obliged  to  do  this.  Pie  asserted  positively  that  he  was 
using  the  most  profane  language  and  condemning  all  the 
Saints  and  the  Virgin,  and  cursing  everything  that  was 
good  and  true.  While  lying  in  bed  or  sitting  quietly 
in  a  chair  he  was  profoundly  impressed  that  he  was  ex- 
pressing in  audible  tones  these  terrible  thoughts. 

In  another  instance,  a  lawyer  in  the  delirious  stage 
posed  and  jesticulated  with  great  energy  many  times 
during  the  day.  His  lips  moved,  but  there  was  no  audible 


DELIRIUM  TBEMENS.  207 

sound.  Then  he  would  sit  down  exhausted.  Then  a 
period  of  remorse  and  regret  would  come  over  him,  and 
apologies  for  his  violent  words. 

In  another  case  the  patient  was  astonished  that  his 
violent  language  made  no  impression  on  others,  and  when 
told  that  his  thoughts  were  not  vocalized,  was  skeptical. 

Disorientation  is  a  very  common  symptom,  particularly 
at  night.  The  surroundings  are  all  confused  and 
changed,  and  the  patient  is  unable  to  recognize  anything 
but  his  delusional  conceptions.  On  the  advent  of  day  this 
condition  disappears. 

In  a  certain  number  of  cases  the  delusions  have  some 
reference  to  some  event  of  the  past  and  its  distressing  in- 
fluence at  the  present.  Delusions  of  burglars  and  persons 
who  seek  to  injure  them  are  very  common,  also  of  the 
infidelity  of  others  and  their  efforts  to  take  advantage 
of  him.  This,  in  many  instances,  is  a  very  significant 
symptom. 

Changed  personality  is  not  uncommon.  The  persons, 
acting  as  if  they  were  in  other  surroundings  and  situa- 
tions and  reasoning  with  some  sanity,  often  committing 
acts  that  are  rational  in  their  new  positions.  Thus  per- 
sons believe  themselves  in  danger  of  fire  or  drowning  in  a 
building  or  boat,  and  will  show  discretion  and  judgment 
in  their  conduct  to  prevent  this. 

In  many  instances  a  man  using  spirits  to  excess  will 
suddenly  decide  to  stop,  and  give  the  most  frivolous  rea- 
sons for  this  radical  change.  For  a  short  time  he  will  be 
serene  and  hopeful,  and  express  himself  in  the  most  ra- 
tional way.  Then  all  at  once  develop  delusions  and 
hallucinations. 

Sometimes  these  are  preceded  by  acute  indigestion  and 
insomnia.  The  delusions  at  first  will  be  transient.  Then 
they  become  fixed.  The  common  opinion  is  that  this  con- 


208  INEBRIETY. 

dition  is  due  to  the  sudden  withdrawal  of  spirits,  but 
the  return  again  to  spirits  makes  little  or  no  impression. 
The  delusive  condition  goes  on  just  the  same,  only  a  little 
more  intense. 

It  is  altogether  probable  that  some  pathological  im- 
pression suddenly  materializes  into  repugnance  for  spirits 
and  desire  to  abstain ;  later  the  toxsemic  state  centered  in 
delusions  and  delirium,  which  was  but  a  continuation  of 
his  former  condition. 

Practically  such  persons  should  receive  very  active  treat- 
ment for  a  time  until  the  possibility  of  an  explosion  in 
the  form  of  a  delirium  has  passed  away.  Persons  who 
come  for  consultation  and  give  a  history  of  sense  decep- 
tions and  mild  delusions,  when  told  that  these  are  symp- 
toms of  delirium  tremcns  are  not  unfrequently  precipi- 
tated into  the  very  conditions  they  seek  to  avoid. 

Thus,  an  inebriate  who  consulted  a  physician  was  told 
that  his  symptoms  meant  an  attack  of  delirium  tremens. 
His  mind  at  once  recurred  to  all  that  he  had  ever  seen 
or  heard  concerning  this  condition,  particularly  in  the 
symptoms  and  the  conduct.  Delirium  tremens  developed, 
following  exact  lines  and  symptoms  which  he  had  observed 
in  others. 

An  instance  in  one  family  where  a  father,  son-in-law, 
and  two  intimate  friends  suffered  from  delirium  tremens 
at  different  times,  the  symptoms  were  identical,  par- 
ticularly in  hallucinations  of  monkeys  coming  through  the 
windows,  climbing  over  the  beds  and  threatening  them 
at  all  times  of  the  night.  They  had  never  seen  or  heard 
of  any  other  form  of  delirium  associated  with  the  vise 
of  spirits.  Hence  this  symptom  was  classical  to  them. 

In  another  instance,  where  a  patient  suffered  from 
hallucinations  of  elephants  walking  on  tight  ropes,  cross- 
ing back  and  forth  over  the  bed,  and  threatening  to  fall 


DELIRIUM  TBEMENS.  209 

on  him  at  any  moment,  these  were  reproduced  in  several 
of  his  friends  who  had  similar  attacks. 

In  a  certain  hospital  the  particular  delusions  are  those 
of  rats  crawling  over  the  beds  and  biting  the  extremities 
of  the  body.  In  another  hospital  all  the  patients  had 
delusions  of  persons  trying  to  shoot  them  through  the 
windows. 

In  the  ward  of  another  hospital,  where  a  trolley  car 
passed  close  to  the  windows,  the  noise  was  interpreted  as 
gun  shots,  thunder  bolts,  and  all  the  alcoholics  made 
tremendous  efforts  to  secrete  themselves. 

Since  the  advent  of  the  telephone,  new  forms  of  delu- 
sions are  coming  into  prominence.  An  active  business 
man  who  drank  steadily  was  seen  to  have  his  telephone 
covered  up  in  the  most  careful  manner.  His  explanation 
of  threatening  voices  indicated  clearly  the  beginning  of  a 
very  serious  delusion. 

Thus,  the  symptomology  of  delirium  tremens  prac- 
tically covers  almost  every  form  of  mania,  delirium  and 
obsession.  The  first  effort  of  the  medical  man  should  be 
to  determine  the  physical  causes  and  how  far  they  are 
influential  in  the  promotion  of  these  mental  states.  A 
toxaemia  from  alcohol  is  to  be  recognized  as  the  most 
active  exciting  cause,  and  its  removal  is  the  most  im- 
portant step  in  the  treatment. 

If  the  patient  has  delusions  of  fear  that  its  sudden  re- 
moval will  precipitate  a  more  dangerous  condition,  this 
must  be  recognized,  and  the  spirits  withdrawn  gradually. 

Elimination  through  the  skin  by  means  of  baths,  and 
by  the  bowels  with  salines,  is  the  most  prominent  pre- 
ventive means.  A  warm  bath,  or  reclining  in  warm  water 
in  a  tub  for  two  or  three  hours  every  day  is  invaluable. 

The  shocks  of  cold  water  on  the  surface,  as  in  a 
cold  pack,  follov.'ed  by  vigorous  rubbing  and  general  re- 


210  INEBEIETY; 

-w 

laxation,  is  a  very  excellent  measure.  Where  baths  and 
showers  can  not  be  used  with  advantage,  sponge  baths 
and  frequent  bathing  of  the  body  will  accomplish  the 
same  purpose. 

The  persistent  insomnia  is  always  self -limited,  and  the 
attempt  to  control  it  by  narcotics  is  full  of  danger.  A 
forced  sleep  by  chemical  measures  still  further  deranges 
the  metabolism  and  lowers  the  vitality.  The  high  mor- 
tality following  the  use  of  narcotic  drugs  is  the  best 
evidence  of  the  danger  of  this  method.  In  institutions 
where  hydropathic  measures  can  be  used,  together  with 
electric  light  and  the  static  breeze,  this  symptom  is  easily 
controlled.  In  private  homes  tub  baths,  hot  and  cold 
packs,  warm  showers  and  reclining,  under  the  care  of  a 
special  nurse  will  accomplish  the  same  purpose. 

The  diet  should  be  restricted  according  to  the  patient. 
Meat  should  be  practically  contra-indicated  and  used  only 
in  small  quantities  and  at  long  intervals.  Nourishing 
soups  and  foods  easily  assimilable  are  most  valuable.  Milk 
and  salines  are  to  be  given  according  to  the  conditions 
present,  and  to  meet  the  particular  wants  of  the  case. 

Very  little  food  should  be  given  the  first  two  days, 
because  of  the  toxsmic  conditions  of  the  body  and  the 
impaired  digestion.  After  that  solid  foods  may  be 
gradually  given  at  short  intervals  through  the  day, 
supplemented  by  fruits  and  acids,  according  to  the  con- 
ditions present. 

Localized  pains  over  the  liver  and  abdominal  organs 
can  best  be  treated  by  local  applications  of  hot  or  cold 
water. 

The  special  treatment  of  delirium  and  delirious  states 
will  vary  largely  according  to  the  man  and  the  direction 
of  the  symptoms.  If  the  delirium  is  destructive,  during 
which  the  patient  tears  and  breaks  everything  around  him, 


DELIRIUM  TREMENS. 


it  is  best  to  have  him  placed  under  a  sheet  and  strapped 
down  on  a  cot  in  the  middle  of  a  floor,  particularly  at 
night. 

In  the  daytime  this  can  be  removed,  and  the  patient 
allowed  to  walk  about  with  an  attendant,  and  if  in  the 
country,  it  is  well  to  go  in  the  open  air.  Where  the 
patient  is  a  strong,  muscular  man,  it  is  found  practical 
to  allow  him  to  exercise  in  the  open  air  for  an  hour  at  a 
time,  until  signs  of  exhaustion  appear,  or  if  the  sur- 
roundings excite  him,  this  exercise  should  be  in  a  room. 

Warm  showers,  sponging  or  lying  in  a  warm  water 
bath  should  follow  this.  If  the  delusions  and  delirium 
are  of  a  harmless  character,  having  reference  to  grotesque 
objects,  or  voices  and  conversations  with  friends,  it  is 
well  to  allow  the  patient  to  have  a  good  deal  of  liberty. 

At  night  he  should  be  put  under  a  restraint  sheet.  An 
improvised  restraint  can  be  made  with  sheets,  passing 
over  the  shoulders  and  arms,  forcing  him  to  recline.  The 
light  should  be  turned  down  and  the  utmost  quietness 
prevail.  Sometimes  the  person  is  more  quiet  where  the 
room  is  well  lighted. 

He  should  have  no  visitors  and  see  only  his  nurse  and 
physician.  The  irregular  heart's  action  should  not  excite 
any  apprehension,  and  no  remedy  should  be  given  for 
tliis  purpose.  The  chief  medication  should  be  elimination 
through  the  bowels,  kidneys  and  skin. 

The  patient  should  be  encouraged  to  drink  water.  If 
he  is  fond  of  mineral  waters,  so  much  the  better.  Meat 
juices  and  milk  are  in  most  cases  disturbing.  Digestion 
should  be  allowed  to  rest,  and  no  fears  of  exhaustion  in  a 
person  well  nourished  should  be  considered.  No  attempts 
should  be  made  to  force  sleep  by  narcotics. 

The  delirium  and  delusions  are  self-limited,  and  in 
most  cases  disappear  suddenly.  After  two  or  three  days 


INEBRIETY. 


of  insomnia  and  restless  activity  the  patient  suddenly 
sleeps,  and  recovery  follows  at  once.  After  free  move- 
ment of  the  bowels,  or  after  a  prolonged  hot  water  bath 
the  same  results  follow. 

Placing  patients  in  a  padded  room,  unless  such  rooms 
are  well-ventilated,  are  open  to  many  objections.  If  the 
patient  can  afford  to  have  the  services  of  two  or  more 
nurses,  the  duration  of  the  disease  may  be  greatly  short- 
ened. 

In  some  of  the  charity  hospitals  well-ventilated  strong 
rooms  are  used,  in  which  the  patient,  after  a  bath,  is 
placed.  If  his  delusions  are  of  a  quiet  form  he  is  al- 
lowed to  remain  on  a  cot  in  a  ward,  but  when  he  be- 
comes boisterous  he  is  taken  to  the  strong  room. 

It  is  noted  that  many  patients  after  being  placed  in 
the  strong  room  exhibit  a  degree  of  restraint  to  keep  from 
being  returned,  showing  a  consciousness  of  their  ab- 
normal acts. 

The  fear  of  collapse  and  an  effort  to  overcome  this  by 
excessive  nutrition  and  drug  stimulation  is  not  only 
dangerous,  but  literally  increases  the  mortality. 

The  general  principle  in  the  treatment  should  be  to 
remove  the  toxsemic  conditions  and  the  local  irritations, 
and  restore  the  mechanical  obstruction  of  the  circulation. 
In  many  cases  there  is  effusion  in  the  brain  and  tissues. 
Metabolism  is  deranged,  digestion  is  impaired,  and  actual 
states  of  starvation  and  toxic  irritation  are  present.  It 
will  be  evident  that  elimination  and  rest  comprise  the 
best  medical  measures  for  restoration.  During  the  de- 
lirious period  pneumonia  and  hemorrhage  arc  the  most 
common  dangers. 

The  excitement  of  the  patient  may  produce  rupture 
of  the  arteries  which  may  be  fatal,  particularly  if  the 
patient  is  given  heart  stimulants  at  this  time.  When  this 
occurs  the  patient  should  be  forcibly  restrained  in  a  re- 


DELIRIUM  TBEMENS.  213 

clining  position,  and  cold  water  applications  to  the  base 
of  the  brain  be  made. 

Pneumonia,  the  result  of  paresis  of  the  pneumogastric 
nerve  can  not  be  anticipated,  but  can  undoubtedly  be  pre- 
cipitated by  reckless  and  excessive  diet.  When  it  occurs, 
hot  applications  over  the  surface  by  spraying  with  a  luco- 
descant  light  constitutes  the  very  best  treatment,  in  addi- 
tion to  the  usual  salines  and  eliminative  measures. 

After  the  delirium  has  subsided,  the  treatment  should 
be  tonics  with  strychnine,  iron,  phosphorous  and  such 
other  remedies  that  have  proven  to  be  of  value,  each  case 
being  very  largely  a  law  to  itself. 

The  prognosis  of  delirium  tremens  is  always  good, 
and  institutional  treatment,  where  it  is  practical,  is  the 
best.  In  private  homes,  trained  nurses  are  necessary,  and 
should  be  strangers  to  the  patient.  Members  of  the 
family  are  not  good  nurses. 

The  very  complex  character  of  this  poisoned  state  in- 
dicates the  very  wide  use  of  physical  and  psychical  meas- 
ures and  is  illustrated  in  the  following  instances:  A 
strong,  vigorous  man  was  attacked  with  wild  delirium  on 
his  yacht,  and  all  efforts  to  restrain  him  were  very  diffi- 
cult. A  friend  of  his  attached  a  rope  to  his  body,  and 
by  diverting  his  attention  threw  him  overboard.  The 
shock  of  the  cold  water  broke  up  the  delusions,  and  the 
fear  of  death  dominated  every  other  thought.  He  was 
pulled  in,  vigorously  rubbed  and  fell  into  a  sound  sleep. 
A  few  hours  later  the  delirium  returned,  and  the  same 
remedy  was  applied.  He  recovered. 

In  another  instance  a  fire  broke  out  in  the  room  of  a 
patient  and  the  excitement  of  removing  him  broke  up  his 
delusion,  and  he  too  recovered. 

As  a  rule,  fear  has  very  little  influence  in  such  cases, 
and  unless  it  is  associated  with  pronounced  eliminative 
measures,  it  is  worse  than  useless. 


INEBEIETY. 


Opium  is  contra-indicated.  The  wide  variation  in  the 
mortality,  ranging  from  two  to  fifty  per  cent.,  indicates 
the  necessity  for  new  and  more  exact  studies  and  the 
application  of  safe  means  and  remedies. 

A  fact  of  considerable  interest  is,  that,  in  many  sections 
of  the  country,  delirium  tremens  is  not  regarded  as  a 
grave  affection. 

A  certain  life  insurance  company  found  a  large  mor- 
tality among  the  insured  in  a  certain  section.  A  special 
agent  found  that  these  fatal  cases  had  repeated  attacks 
of  delirium  tremens,  and  the  local  authorities  and  exam- 
iners had  regarded  this  affection  as  a  temporary  derange- 
ment, and  not  at  all  impairing  the  longevity  risk. 

A  very  important  question  has  been  raised,  whether  an 
attack  of  delirium  tremens  left  a  permanent  impairment 
on  the  brain  and  nervous  system,  and  whether  the  person 
should  be  considered  strong  and  well  after.  This  is  an- 
swered variously,  according  to  the  estimate  of  the  physi- 
cian. 

It  may  be  stated  as  a  general  fact  that  after  such  an 
attack  there  is  always  feebleness,  mental  instability  and 
susceptibility  to  toxic  states  with  lowered  vitality.  The 
fact  of  having  had  delirium  tremens  is  an  important 
factor  in  the  history  of  the  patient  in  disputed  cases  of 
mental  soundness. 

A  number  of  very  interesting  cases  have  been  reported 
of  persons  who,  after  an  attack  of  delirium,  entered  upon 
a  career  of  crime,  and  showed  a  great  moral  weakness  and 
disregard  of  their  ethical  relations  to  the  community. 
Using  alcohol  again  after  such  an  attack  is  followed 
by  a  more  pronounced  mental  disturbance  and  graver 
symptoms  of  disability. 

Many  instances  are  noted  of  tuberculosis  following  an 
attack  of  delirium  tremens.  Pneumonia,  without  any  spe- 
cial exciting  cause,  is  also  frequently  noted.  Bright's 


DELIRIUM  TREMENS.  215 

Disease  is  another  common  sequela.  In  the  two  latter  the 
acute  symptoms  seem  to  be  very  rapid,  terminating 
fatally. 

In  tuberculosis  a  slower  progress  is  common.  Recovery 
from  the  effects  of  delirium  may  be  followed  by  extreme 
susceptibility  to  the  use  of  spirits,  and  an  intense  craze 
for  their  use  when  debilitated  and  exhausted. 

Often  associated  with  this  is  a  mental  repulsion,  which 
is  emotional  in  its  manifestations,  but  is  easily  overcome 
by  fatigue  and  weariness.  The  fact  that  the  man  has 
had  one  attack  of  delirium  tremens  is  always  to  be  re- 
garded in  the  consideration  of  other  diseases,  and  other 
mental  conditions. 

He  is  far  more  likely  to  have  a  second  attack  from  the 
use  of  a  smaller  quantity  of  spirits  than  before,  and  the 
second  attack  will  be  more  intense  in  both  the  depression 
of  his  vital  forces  and  the  irritation  of  his  brain  and 
nervous  system. 

There  is  an  instability  of  brain  co-ordination  that  did 
not  exist  before,  and  a  distinct  tendency  to  take  on 
delirious  and  delusional  states  from  the  slightest  exciting 
causes.  Delusions  of  persecution  and  injury  by  others 
never  disappear  entirely  in  some  cases. 

The  later  life  of  such  persons  is  marred  by  want  of 
confidence  and  undue  suspicion,  no  matter  how  temperate 
they  may  live.  There  is  lowered  mentality  and  defective 
sense  impressions,  with  faulty  reasoning  of  the  motives 
and  purposes  of  others. 

Many  of  these  cases  are  undoubtedly  seriously  in- 
jured by  drug-taking,  particularly  narcotics,  and  forced 
nutrition.  Efforts  to  control  the  delirium  and  produce 
chemical  sleep  are  dangerous.  The  great  central  fact 
to  be  made  prominent  is  that  these  cases  are  self -limited, 
and  the  best  efforts  of  medical  science  are  to  eliminate  the 
toxzemic  conditions  and  prevent  the  patient  from  injur- 


216  INEBRIETY. 

ing  himself,  and  keep  him  in  the  very  best  conditions  and 
surroundings. 

Beyond  this  there  must  be  treatment  of  local  condi- 
tions, dependent  on  the  states  present  of  the  mind  and 
body,  and  the  available  surroundings. 


CHAPTER  XXI. 

FIRST  CLINICAL  EXAMINATION  AND  STUDY  OF  THE 
PATIENT. 


Synopsis. —  Condition  of  the  patient  on  admission.  What  to  ob- 
serve. Distinct  classes  of  symptoms.  The  paralysis  and  its  sig- 
nificance. Its  disappearance  after  a  short  time.  Physical  symptoms 
which  remain.  Mental  symptoms  of  delirium  and  mania  also  of 
delusions.  Character  of  the  delusions.  Symptoms  of  the  voice 
and  the  use  of  language.  First  effects  of  the  use  of  alcohol.  The 
conditions  when  first  used.  Diseases  which  have  preceded  it. 
Heredity  and  its  effects.  Patients  who  have  no  fixed  convictions. 
Patients  filled  with  delusions.  Patients  who  are  dependent  and 
who  are  called  contagious  cases.  Patients  without  any  psychic 
conception  of  life.  Patients  who  are  introspective.  Patients  who 
have  concealed  delusions  and  motives.  Statements  of  patients 
Paroxysmal  drinkers.  Steady  users  of  spirits.  Irregular  and 
accidental  drinkers.  Significance  of  the  various  early  symptoms. 


As  a  rule,  patients  coming  under  observation  are  either 
intoxicated  or  in  the  period  of  remorse  after  the  acute 
symptoms  have  subsided.  If  in  the  state  of  intoxication, 
either  of  stupor  or  delirium,  a  careful  study  of  the 
symptoms  should  be  made.  The  degree  of  stupor,  and 
how  far  it  is  associated  with  muscular  paralysis,  par- 
ticularly in  walking.  Observe  whether  the  body  sways 
from  side  to  side,  or  is  projected  forward,  in  irregular 
angles.  Observe  the  position  of  the  head,  the  laxity  or 
rigidity  of  the  muscles  of  the  neck,  arms  and  legs,  and 
also  the  fingers,  and  the  spasmodic  conditions. 

Note  the  pallor  or  congestion  of  the  face,  the  dryness 
or  perspiration,  the  warmth  or  chilliness  of  the  hands 
and  feet,  the  eyes  and  the  position  of  the  mouth,  and  the 
manner  of  expression ;  also  the  tongue,  and  the  ability  to 
protrude  it.  Inquire  about  the  condition  of  the  kidneys 
and  bowels,  if  the  latter  are  relaxed  or  costive,  the  inco- 
ordination  and  the  changes  of  the  heart's  action  on 
lying  down  or  sitting  up. 

217 


218  INEBRIETY. 

The  sound  of  the  voice,  when  of  stridulent  character 
or  higher  in  tone,  indicates  defective  hearing,  and  irri- 
tation of  the  mucus  membrane.  A  physical  examination 
at  this  time  frequently  reveals  many  very  significant 
symptoms,  particularly  enlargement  of  the  liver,  heart 
and  perhaps  dilation  of  the  stomach. 

The  urine  may  be  loaded  with  albumen  and  phosphates, 
as  well  as  casts.  The  reflexes  may  be  exaggerated  or 
diminished ;  sensitive  areas  may  be  noticed  in  the  spine. 
Congestion  of  the  retina  may  be  present,  and  very  high- 
tensioned  arteries.  These  symptoms  disappear  after  a 
time  and  are  not  to  be  regarded  as  of  value  except  for 
the  purpose  of  comparison. 

After  three  or  four  weeks'  treatment  nothing  remains 
but  an  enlarged  liver,  high-tensioned  arteries  and  perhaps 
an  irritable  heart.  If  the  patient  is  delirious,  the  form 
and  direction  of  the  delirium  should  attract  attention. 
The  character  of  the  delusions,  whether  concerning  himself 
or  others,  particularly  his  conception  of  his  present  con- 
dition, and  how  much  of  it  is  due  to  the  spirits  taken,  and 
how  much  in  his  opinion  is  the  result  of  mistakes  of  his 
associates  and  surroundings,  also  his  use  of  language  in 
describing  this  condition.  His  power  of  discrimination 
in  the  use  of  words,  and  the  use  of  violent  expletives  and 
oaths ;  also  whether  words  flow  in  a  continuous  stream, 
without  much  reference  to  the  thought  they  express.  Is 
he  voluble  and  garrulous  in  his  statements,  or  reserved  and 
emphatic  in  the  use  of  expletives? 

Is  the  mania  one  of  egotism,  in  which  his  conception 
of  power  is  exaggerated,  and  has  he  confidence  in  his 
ability  to  do  as  much  as  other  persons,  or  more ;  or,  is 
his  mania,  while  egotistical,  fixed  on  delusions  of  per- 
secution and  revenge,  for  real  or  imaginary  acts  of  others? 

Is  it  concentrated  on  his  stomach  and  dietetic  wants, 
or  on  his  ability  to  discern  the  motives  and  purposes  of 
others  ? 


FIEST  CLINICAL  EXAMINATION  AND  STUDY.       219 

Three  conditions  must  be  considered.  One,  the  stupor- 
ous,  paralyzed  inebriate,  who  is  entering  upon  the  stages 
of  dementia;  another,  the  wild,  delirious  egotism  which 
is  a  symptom  of  general  paralysis,  and  the  third,  a 
maniacal  conception  of  his  ability  to  overcome  opposition, 
which  indicates  mania. 

These  three  conditions  are  significant.  Where  the  use 
of  spirits  is  paroxysmal,  with  distinct  free  intervals, 
neurotic  and  psychopathic  symptoms  are  to  be  expected, 
particularly  in  the  free  intervals,  and  their  unexpected 
manifestation  in  some  strange  symptom  before  the  spirits 
were  taken. 

If  a  long  period  of  the  so-called  moderate  use  of  spirits 
has  preceded  the  present  condition,  degrees  of  mental  and 
physical  degeneration,  evident  in  reasoning,  conduct,  acts 
and  irregularities  of  health,  are  to  be  expected.  If  the 
use  of  spirits  has  followed  injury,  disease  or  some  special 
shock,  either  mental  or  physical,  organic  changes  are  to 
be  expected,  and  both  local  and  constitutional  defects  will 
be  found. 

A  careful  study  of  the  effects  of  alcohol,  with  the  first 
glass  or  first  intoxication,  will  point  out  a  susceptibility, 
immunity  or  some  idiosyncrasy  that  will  be  very  sig- 
nificant in  future  studies.  If  the  history  shows  that 
alcohol  exalted  the  sensory  activities,  and  the  depression 
only  followed  as  a  second  stage,  this  fact  is  to  be  noted. 

If  the  first  use  of  alcohol  produced  narcotism,  general 
stupor  and  profound  derangement  afterwards,  this  is 
equally  significant.  Heredity  is  a  very  powerful  factor, 
and  where  it  is  possible,  should  be  studied  with  care. 
The  children  of  alcoholic  parents  have  always  lowered 
vitality  and  feeble  resisting  power,  and  are  very  liable  to 
profound  and  continuous  exhaustion  and  hypersensitive- 
ness  to  the  effects  of  spirits. 


220  INEBRIETY. 

In  many  instances  spirits  are  repcllant  and  painful  at 
the  start,  but  this  may  be  overcome.  Often  the  heredity 
from  grandparents  develops  in  an  unexpected  use  of 
spirits  and  a  fascination  for  its  effects,  with  or  without 
any  tangible  causes.  Where  they  are  neurotics,  and 
psychasthenics,  a  study  of  the  early  life  of  the  children 
will  indicate  Arery  clearly  much  of  the  future. 

The  physical  defects  in  growth  of  the  body  and  the 
history  of  prccosity  or  stupidity  in  early  life,  also  the 
hygienic  training,  dietetic  and  mental  care  are  to  be 
studied.  Often  diseases  of  childhood,  and  their  severity 
and  entailments,  give  unmistakable  indications  of  the  in- 
ebriety in  later  life. 

When  the  patient  is  in  a  remorseful  stage,  a  careful 
study  of  his  own  conceptions  about  his  present  and 
future  give  very  prominent  signs  of  the  injuries  from 
alcohol,  and  its  neurotic  basis.  Oftentimes  the  ex- 
aggerated conceptions  of  his  present  condition  and  his 
reasoning  of  their  causes  point  out  changes  in  the 
organism. 

In  this  stage  his  credulity  and  anxiety  to  secure  help 
and  to  recover,  his  reluctance  and  skepticism  of  the 
various  means,  and  his  hesitation  about  following  advice, 
are  all  most  significant  symptoms.  When  the  egotism 
of  the  patient,  after  recovery  from  acute  symptoms,  in- 
sists on  freedom  from  all  restraint  and  the  gratification 
of  every  appetite,  the  condition  is  dangerous,  and  sug- 
gests paresis. 

When  patients  have  no  fixed  convictions,  and  minimize 
their  present  conditions,  and  enjoy  the  fact  of  having 
used  spirits,  and  talk  of  the  possibility  of  moderate 
drinking,  the  paralysis  is  profound.  The  delusion  of 
infidelity  of  relatives  and  friends  and  of  the  dishonesty 
and  intrigue  of  others,  signify  the  same  condition.  Con- 
cealed delusions  are  to  be  looked  for  in  a  study  of  the 


FIRST  CLINICAL  EXAMINATION  AND  STUDY. 


disappointments,  and  diseases  and  strains  which  have  fol- 
lowed, also  states  of  exhaustion  and  derangement,  which 
have  accompanied  and  probably  preceded  the  excessive 
use  of  spirits,  are  also  to  be  studied. 

After  the  acute  symptoms  have  passed  away  the  psychic 
conditions,  both  present  and  past,  should  be  studied.  In 
many  cases  the  patient  is  born  without  ability  to  act 
alone,  and  without  distinct  personality  to  regulate  his 
life  and  conduct;  he  is  dependent  on  the  surroundings, 
society  and  friends,  and  follows  the  personality  of  others. 

Many  patients,  through  overcare  of  their  parents,  have 
never  developed  an  initiative  dependence  on  themselves  in 
the  common  every-day  matters.  They  have  been  depend- 
ent on  others,  and  have  grown  up  trusting  to  external 
conditions,  circumstances  and  surroundings.  These  are 
very  significant  questions  in  the  study  of  the  case.  A 
study  of  diet,  sleep,  and  exercise  will  point  out  many  con- 
ditions which  explain  the  present  state. 

While  the  patient's  conception  of  his  own  condition 
should  always  be  sought,  it  should  never  be  followed, 
except  as  a  mere  indication  of  the  real  facts;  which  must 
be  gathered  from  all  sources  and  inferred  as  natural  con- 
sequences. The  idea  of  the  uniform  action  of  laws  of 
dissolution  and  disease  will  become  more  and  more  prom- 
inent from  exhaustive  studies. 

The  form  in  which  alcohol  is  taken  and  the  time  and 
the  particular  effects  are  by  no  means  chance  or  accident- 
al, and  are  not  dependent  on  the  capricious  will  of  the 
patient.  Often  the  appearance  of  the  parents  or  the 
relatives  of  the  patient  furnishes  confirmatory  facts  of  the 
race  degeneracy,  or  the  peculiarities.  Patients  who  dwell 
on  the  minute  causes  and  conditions  which  provoke  the 
drink  craze  and  the  result  of  it  are  suspicious  and  should 
be  studied  with  great  care. 


222  INEBRIETY. 

Frequent  examinations  have  a  mental  effect  and  often 
disclose  facts  concealed  before.  The  first  effort  should  be 
to  secure  the  confidence  of  the  patient,  and  have  him  talk 
freely  of  his  entire  life,  then  take  his  statements  under 
consideration,  recognizing  them  as  biased  and  uncertain, 
to  be  studied  for  confirmation  and  support  by  other  facts. 

On  matters  pertaining  to  themselves,  the  reasoning  of 
the  patients  may  be  very  acute,  or  it  may  be  misleading, 
and  the  first  examination  will  bring  out  this  fact  and  in- 
dicate what  general  line  of  causes  have  been  influential  in 
producing  the  condition  present,  and  the  possible  trend 
and  direction  of  these  states. 


CHAPTER  XXII. 

GENERAL  PRINCIPLES  OF  TREATMENT. 


Synopsis. —  Certain  general  principles  to  be  recognized  in  every 
case.  Particularly  after  the  subsidence  of  the  acute  stages.  Pa- 
tients unconscious  of  their  conditions.  A  suspicious  egoism  very 
prominent.  A  delusional  confidence  in  the  will-power.  The  per- 
iodic drinker  recognizes  the  need  of  help.  The  moderate  drinker 
never.  Theories  of  the  causes  are  always  misleading.  The 
patient's  estimation  of  his  condition  should  not  be  followed.  The 
diagnosis  and  prognosis  always  uncertain  unless  studied  exhaus- 
tively. Questions  of  rapid  or  slow  withdrawal  are  misleading. 
Treatment  for  insomnia,  gastritis.  Common  early  symptoms  are 
important.  Studies  to  ascertain  the  exact  causes  both  physical  and 
psychical  essential.  Studies  to  determine  the  acute  exciting  causes 
very  important.  The  removal  of  these  is  followed  by  restoration. 
Examples  of  the  acute  causes.  General  treatment  necessary,  par- 
ticularly on  the  subsidence  of  the  active  causes.  Certain  general 
principles  always  to  be  recognized.  Not  theories,  but  prominent 
facts  supported  by  evidence. 


In  a  study  of  the  principles  of  treatment  there  are  some 
general  facts  which  appear  in  nearly  all  cases  which  fur- 
nish the  groundwork  or  basis  from  which  further  study 
and  treatment  must  begin.  One  fact  stands  out  prom- 
inently, that  the  patients  coming  under  treatment  are 
never  in  what  is  called  the  early  stages  of  the  disease,  but, 
on  the  contrary,  they  have  reached  a  degree  of  chronicity 
which  has  produced  alarm  and  anxiety  among  their 
friends  and  in  themselves. 

Commonly  such  treatment  is  for  cases  of  acute  intox- 
ication. When  this  condition  subsides  the  patient  may  be 
convinced  that  he  needs  further  help,  particularly  when 
pressed  by  his  friends,  and  may  consent  to  receive  medical 
care  and  treatment. 

In  such  cases  he  is  very  largely  unconscious  of  his  true 
condition.  He  will  reason  that  his  danger  is  very  slight 
and  insignificant  and  the  symptoms  which  his  friends  are 
anxious  about  are  of  little  account,  and  that  he  has 

223 


INEBRIETY. 


full  power  to  care  for  himself,  if  he  should  choose  to  'ex- 
ercise it. 

This  strange  unconsciousness  of  the  meaning  of  the 
phenomena,  direct  or  indirect,  from  the  use  of  spirits  is 
common  to  nearly  all  cases.  He  may  have  drunk  to  ex- 
cess in  the  past,  acted  strangely,  done  many  insane 
things,  yet  the  passing  off  of  these  conditions  brings 
with  it  a  delusional  confidence  that  he  will  never  drink 
again,  and  that  all  these  symptoms  are  transient. 

The  periodic  drinker  rarely  acknowledges  the  need  of 
medical  help,  except  at  some  particular  period  of  his 
drink  paroxysm.  Even  then  his  confidence  is  only  slight- 
ly shaken  in  his  ability  to  stop  at  will. 

The  steady  drinker  is  more  positive  and  continues  to 
believe  that  he  has  free  will  to  stop  at  any  time.  When 
asked  to  explain  why  he  does  not,  refers  to  some  slight 
temporary  external  or  internal  causes,  which  seem  to  him 
a  sufficient  reason. 

In  appearance  the  continuous  drinker  has  more  prom- 
inent marks  of  alcoholic  degeneration  than  the  periodic 
drinker.  These  are  often  seen  in  the  eyes,  face,  walk,  ab- 
rupt manners  and  language. 

There  is  a  wide  variation  in  the  mental  and  physical 
symptoms  of  inebriety  ranging  all  the  way  from  the  man 
with  the  slight  alcoholic  breath,  up  to  the  delirium  of 
intoxication  and  the  stage  of  stupor. 

One  of  the  most  prominent  mental  symptoms  is  a  paretic 
exaltation  and  egotistical  confidence  in  his  strength  and 
vigor.  He  will  deny  that  he  has  ever  taken  any  spirits 
when  the  exhalations  from  his  breath  disprove  it.  He  will 
give  the  most  absurd  reasons  in  explanation  of  unusual 
symptoms  and  believe  that  he  has  convinced  his  hearers. 

A  careful  scrutiny  will  reveal  muscular  palsy,  local 
ticks  and  twitching  of  the  nerves  with  a  confused  sensory 
activity.  These  are  in  the  early  stages.  Later,  when 


GENERAL  PRINCIPLES  OF   TREATMENT.  225 

positive  delirium  and  stupor  comes  on,  they  are  recog- 
nized. 

Another  symptom  is  very  common  to  all  persons  who 
use  spirits,  namely,  inaccuracy  of  statement,  faulty  use  of 
words  that  have  double  meanings.  This,  with  irritability 
and  disposition  to  be  critical,  minimizing  their  own  con- 
ditions and  magnifying  the  opinions  and  judgment  of 
others. 

Often  a  drinking  man  reveals  his  condition  by  his  de- 
lusional reasoning,  concerning  himself  and  others.  This 
is  seen  particularly  in  efforts  to  explain  his  condition  and 
the  cause  of  his  drinking.  To  persons  not  familiar  with 
this  class,  the  excessive  minute  and  dogmatic  explanations 
are  very  convincing  and  even  his  physicians  accept  his 
statements  of  his  own  case  without  making  special  con- 
firmatory studies. 

Thus  the  diagnosis  and  prognosis  of  patients  not  de- 
lirious and  stupid  are  always  misleading  when  based  on 
the  statements  of  the  patients  and  their  friends.  When  the 
toxic  symptoms  are  prominent  the  inferences  are  more 
positive  and  clear. 

The  intensely  red  or  blanched  face  points  to  disorders 
of  circulation.  The- dilated  or  contracted  pupils  indicate 
pressure  and  change  in  the  central  organ.  The  acute  in- 
flammatory conditions  and  nutritional  disturbances  are 
most  significant  of  toxic  and  general  derangement. 

In  most  cases  there  is  an  intense  demand  for  help,  in 
others  great  indifference  and  reluctance  to  receive  any  as- 
sistance. Most  patients  seek  relief  when  the  drink  craze 
has  subsided  and  a  stage  of  remorse  and  depression  brings 
out  an  increased  consciousness  of  the  gravity  of  their  con- 
dition. 

At  this  time  there  is  mental  feebleness  and  delusional 
conceptions  expressed  in  extravagant  language  concerning 
themselves  and  their  danger.  This  has  great  therapeutic 


226  INEBRIETY. 

significance  to  the  physician,  suggesting  localized  de- 
pressions and  toxic  poisonings  which  may  deepen  into 
serious  organic  changes  or  pass  away  by  the  efforts  of 
nature. 

It  is  at  this  time  that  the  specific  treatment  with  its 
credulities  and  its  extravagant  expectations  appeal  most 
vividly  to  the  reason  of  the  patient. 

Physical  and  mental  measures  which  attempt  to  increase 
this  sense  of  danger  and  the  physical  depression  often 
have  the  very  opposite  effects.  Narcotics,  emetics,  and 
other  drugs  act  in  this  way  and  psychological  measures 
to  deepen  the  mental  impression  are  exceedingly  uncer- 
tain. 

Efforts  to  shock  the  patient  by  exaggerating  his  fears 
and  increasing  the  magnitude  of  his  danger  are  exceed- 
ingly unsafe.  This  topic  is  referred  to  in  another  chap- 
ter. 

The  appeal  of  the  patient  for  relief  should  be  followed 
by  pronounced  eliminative  measures,  removing  the  active 
and  predisposing  causes  and  placing  the  patient  in  the 
very  best  conditions  for  restoration. 

Then  the  questions  of  nutrition,  elimination,  environ- 
ment and  mental  impressions  become  the  subject  of  more 
exhaustive  studies.  Where  persons  have  used  spirits  for  a 
very  long  time,  there  is  a  delusion  that  unless  its  removal 
is  gradual,  there  is  fear  of  collapse  and  heart  failure. 

Oftentimes  the  patient  is  so  impressed  with  this  idea 
that  the  sudden  removal  of  spirits  must  be  considered  in 
the  treatment.  Where  spirits  are  removed  gradually,  the 
continuation  of  the  poisonous  effects  must  be  recognized. 
The  mental  impression  that  collapse  will  follow  the  with- 
drawal of  spirits  must  be  met  and  neutralized  according 
to  the  conditions  present. 

A  common  custom  of  giving  nitrate  of  strychnine  with 
every  dose  of  spirits  until  the  latter  is  painful  has  many 


GENERAL   PRINCIPLES    OF   TREATMENT.          227 

advocates.  The  freedom  from  danger  of  collapse  is  il- 
lustrated in  the  number  of  intoxicated  persons  confined  to 
the  station  houses  who  are  seldom  given  any  spirits  after 
being  locked  up,  and  mortality  is  rarely  traced  to  this 
cause. 

It  must  be  remembered  that  there  is  greater  peril  and 
danger  in  the  slow  withdrawal  of  spirits,  states  of  con- 
gestion, sudden  palsies  as  of  pneumonia,  nephritis  and 
other  local  inflammations,  suddenly  starting  up,  are  very 
common. 

Changing  the  form  of  spirits  and  combining  them  with 
eggs  or  foods  bring  additional  perils  from  autotoxic 
causes,  and  rather  protracts  the  trouble  and  increases  the 
fatality. 

Extensive  experience  shows  that  the  gradual  withdrawal 
of  spirits  in  the  treatment  is  followed  by  great  complex- 
ities of  symptoms,  prolonged  convalescence  with  great  ex- 
haustion and  slower  recovery. 

A  study  of  many  thousands  of  persons  in  whom  spirits 
were  withdrawn  at  once  has  never  indicated  any  deaths 
from  collapse  that  could  be  attributed  to  this  cause. 

Often  sharp  eliminative  measures  through  the  skin  and 
bowels  with  warm  baths  and  rest  in  dark  rooms  bring  out 
a  repugnance  for  both  the  smell  and  taste  of  spirits. 
Acute  gastritis  and  general  hyperaemia,  calling  for  relief, 
suggesting  spirits  as  the  only  possible  remedy,  is  very 
easily  overcome  by  hydropathic  measures,  together  with 
appropriate  mineral  waters. 

All  the  specific  cures  depend  on  the  combined  action  of 
atrophia  and  hyoscine  to  diminish  the  craving  for  spirits. 
This  is  more  or  less  perilous  when  applied  without  due 
discrimination.  Many  of  the  vegetable  bitters,  particu- 
larly in  the  form  of  infusions,  have  a  revulsive  effect  in 
breaking  up  the  desire  for  drink.  Elsewhere  we  have 
noted  this  fact. 


228  INEBRIETY. 

When  the  desire  for  drink  has  passed  away,  the  condi- 
tions due  to  the  poisonous  action  of  alcohol  come  into 
prominence.  Thus  the  faults  of  circulation  and  elimina- 
tion, the  local  palsies,  the  unstable  nerve  centers  with  ex- 
plosive tendencies,  also  the  nutritional  disturbances  and 
morbid  impulses  for  foods  and  drinks  are  the  conditions 
which  require  recognition  and  therapeutic  measures  for 
relief. 

Insomnia  is  a  very  common  condition.  When  treated 
by  narcotics,  is  often  made  worse.  The  forced  sleep  is  at 
the  expense  of  vitality  and  nutrition  with  greater  intensity 
of  the  toxaemic  states  which  may  have  been  an  active  cause 
in  producing  it. 

The  treatment  of  gastritis  and  insomnia  by  narcotics 
has  often  ended  fatally  and  the  death  certificate  was  heart 
disease,  when  it  should  have  been  heart  failure  from  drugs. 
The  remedies  advised  in  the  text  books  for  these  condi- 
tions resulting  from  toxic  poisonings  are  not  to  be  relied 
upon.  In  reality  there  is  a  very  wide  difference  between 
theory  and  practice  here. 

Authors  are  not  familiar  with  the  condition  and  write 
from  a  theoretical  point  of  view,  giving  very  dangerous 
advice.  It  is  always  a  question  in  the  treatment  of  acute 
cases  of  inebriety  and  the  acute  inflammations  which  fol- 
low, of  avoiding  the  use  of  drugs  which  complicate  and 
increase  the  danger. 

The  subsidence  of  the  active  symptoms  brings  out  new 
questions  of  causes  and  conditions  and  suggests  new  meas- 
ures of  treatment  which  were  not  practical  before.  Thus 
in  some  instances  a  most  efficient  remedy  is  a  change  of 
environment  and  occupation. 

In  another  it  is  a  change  of  nutrition  and  exercise,  sleep 
and  rest.  In  another  it  is  nerve  rest  and  quietness  in  a 
sanatorium,  or  a  home  in  the  country.  A  long  list  of 
very  active  and  contributing  causes  should  be  studied  and 


GENERAL   PRINCIPLES    OF   TREATMENT.          £29 

removed.      Then   the   progress   towards   recovery   will   be 
rapid  and  positive. 

Not  imfrequently  climatic  conditions  produce  depres- 
sion and  irritation,  which  provokes  the  drink  craze.  When 
these  are  changed  restoration  is  rapid.  Innumerable  ex- 
amples appear  of  apparently  insignificant  causes,  which 
when  removed  result  in  the  restoration  of  the  patient. 

Such  causes  are  generally  toxaemic  or  have  reference 
to  the  toxaemic  condition  of  the  body.  Thus,  in  one  in- 
stance, a  chronic  case  was  required  to  walk  twice  a  day  to 
a  spring  for  certain  mineral  waters,  two  miles  away,  and 
drink  certain  quantities  of  the  water.  He  recovered.  The 
muscular  exercise  in  the  open  air  was  of  more  value  than 
the  waters  he  drank. 

In  another  example  the  treatment  for  hyperacidity  of 
the  stomach  with  regulation  of  the  diet  and  prolonged 
rest  in  bed  was  followed  by  permanent  restoration.  These 
cases  indicate  the  possibilities  of  exciting  causes,  that  are 
unknown  to  the  person,  and  only  recognized  by  careful 
study. 

It  is  also  evident  that  many  complex  psychoneuroses 
exist  which  are  not  overcome  by  specifics  or  drug  cures. 
When  they  are  removed,  the  progress  towards  recovery  is 
rapid.  In  every  case  there  should  be  a  general  study  of 
the  most  prominent  causes,  or  conditions  that  favor  and 
encourage  the  use  of  spirits. 

At  one  time  it  may  be  contagion  from  example  of  oth- 
ers, or  it  may  be  the  contagion  of  surroundings.  In  one 
instance  a  man  never  drank  except  at  the  club.  In  an- 
other he  could  not  resist  the  invitations  of  certain  men  to 
join  them  in  the  social  glass.  To  all  others  he  could  re- 
fuse. Having  taken  one  glass  it  was  impossible  to  stop 
until  he  had  become  thoroughly  intoxicated. 

Often  conditions  of  starvation,  both  mental  and  phys- 
ical, furnish  very  active  predisposing  causes  for  the  drink 


230  INEBRIETY. 

craze.  Remove  these  and  the  person  becomes  an  abstainer 
at  once.  Very  important  questions  occur  as  to  the  value 
of  drugs  and  chemical  restraint,  and  how  far  it  can  be 
used  with  safety. 

To  depend  upon  drugs  alone  is  certainly  perilous,  also 
to  depend  upon  restraint.  In  much  the  same  way  mental 
impressions  are  transient  and  by  themselves  alone  are  fol- 
lowed by  sad  failure.  It  is  only  from  an  exhaustive  study 
of  the  conditions,  both  inherited  and  acquired,  that  the 
therapeutic  measures  and  remedies  can  be  determined. 

The  fact  should  never  be  overlooked  that  the  inebriate 
is  a  most  complex  neurotic  and  that  the  mere  use  of  spirits 
is  by  no  means  the  only  cause.  In  reality  it  may  be  sec- 
ondary and  contributory,  and  these  facts  should  be  recog- 
nized in  the  question  of  treatment. 

The  general  principles  of  treatment  include  every  pos- 
sible degenerative  influence,  both  physical  and  psychical, 
and  should  not  be  based  on  any  one  set  of  facts  to  the 
exclusion  of  others.  While  one  cause  may  be  more  prom- 
inent than  another,  their  relations  should  be  studied. 

As  an  example,  the  subsidence  of  the  acute  symptoms  of 
tuberculosis  is  marked  by  an  intense  desire  for  spirits. 
Traumata  and  shocks  not  unfrequently  set  up  an  alcoholic 
craze.  Reflex  irritations  are  not  infrequently  apparent 
in  the  same  symptoms,  and  the  treatment  must  necessarily 
vary  when  these  causes  are  recognized. 

Hence,  the  general  principles  for  treatment  must  be 
understood  at  the  beginning,  and  with  this  in  view,  ra- 
tional means  and  measures  can  be  applied. 


CHAPTER  XXIII. 
HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES. 

Synopsis. —  The  recent  character  of  such  treatment.  Former 
theories  of  intoxication  obscure  the  need  for  treatment.  A  dis- 
tinct business  in  the  hotels  of  the  large  cities,  also  by  charlatans 
In  certain  centers.  Question  of  how  often  one  can  be  acutely 
intoxicated  and  recover.  Acute  intoxication  very  serious  con- 
dition. Doubtful  if  full  recovery  ever  takes  place.  The  steady 
drinker  is  much  weaker  and  requires  more  careful  study.  Reme- 
dies used  to  restore  one  who  drinks  steadily.  Apomorphia  has 
some  value.  Opium  extracts  should  not  be  used.  Danger  in 
careless  treatment  of  persons  found  intoxicated  in  the  streets. 
Three  classes  of  persons  commonly  call  physicians  for  temporary 
relief.  One  in  which  intoxication  is  the  direct  result  of  spirit 
poisoning.  The  other,  when  the  toxic  conditions  come  on  suddenly 
and  without  particular  reasons.  The  third  so-called  temperate 
persons  who  become  intoxicated  from  causes  other  than  spirits. 
The  general  treatment  of  such  cases.  Danger  in  using  the  needle. 
Value  of  water  treatment.  Conditions  to  be  sought  for.  Nar- 
cotics should  not  be  used.  Examples  of  cases  restored  by  family 
physicians.  Office  patients.  Failure  to  recognize  their  conditions. 
Disastrous  results.  Examples.  Some  remedies  found  valuable. 
Number  of  patients  calling  for  medical  treatment  increasing. 
An  unknown  field  of  very  great  promise.  Experience  of  em- 
pirics shows  possibilities  of  means  and  measures. 

Up  to  a  very  recent  period  medical  men  were  seldom 
called  to  give  assistance  or  prescribe  for  inebriates,  ex- 
cept in  cases  of  acute  intoxication  and  chronic  conditions. 

The  apparent  self -limited  and  transient  nature  of  or- 
dinary intoxication  seems  to  require  little  or  no  medical 
help,  and  the  rapid  recovery  confirmed  this  impression. 

The  theory  that  inebriety  is  in  its  origin  a  moral  dis- 
order has  discouraged  the  inclination  to  call  for  a  physi- 
cian, and  with  it  an  increased  sense  of  humiliation  after 
the  act  and  desire  to  conceal  it.  Only  when  intoxicated 
persons  become  wildly  delirious,  or  excessively  stupid  are 
the  family  and  friends  alarmed;  the  physician  is  then 
called. 

The  subsidence  of  these  acute  symptoms  is  not  restora- 
tion or  cure,  and  yet  the  impression  is  that  the  patient 

231 


232  INEBRIETY. 

has  recovered.  In  reality  the  injury  to  the  organism  is 
very  serious  and  complex,  and  far  more  dangerous  be- 
cause it  is  concealed. 

During  the  last  few  years  the  medical  treatment  of  the 
acute  stages  of  intoxication  have  become  quite  a  distinct 
and  prominent  business,  especially  by  hotel  physicians  in 
large  cities,  and  also  by  charlatans  and  quacks  who  make 
great  pretensions  of  permanent  cure. 

Acute  intoxication  or  alcoholism  is  marked  by  delirium, 
coma,  and  general  paralysis,  following  profound  toxaemias 
with  marked  symptoms  of  grave  disturbance  of  both 
the  motor  and  sensory  centers.  There  are  always  func- 
tional changes  and  profound  pathological  disturbances 
in  the  organism,  which  by  repetition  would  become 
permanent,  and  in  all  cases  there  are  unknown  degenera- 
tions that  may  or  may  not  pass  away. 

The  question  has  been  raised  how  far  the  organism, 
particularly  the  brain  and  nervous  system  can  endure 
these  toxic  states,  and  preserve  their  normal  integrity;  in 
other  words,  how  many  times  may  a  person  become  deliri- 
ous or  stupid,  and  be  intoxicated  from  the  effects  of  spir- 
its, and  fully  recover? 

One  observer  thinks  that  few  persons  ever  live  to  be- 
come intoxicated  more  than  400  or  500  times.  Others 
estimate  300  as  the  extreme  limit.  The  probabilities  are 
that  few  persons  ever  become  profoundly  intoxicated  more 
than  100  times  and  recover.  General  collapse,  local  in- 
flammations and  profound  palsies  and  intercurrent  dis- 
eases take  place  long  before  the  limit  of  100  or  more  in- 
toxications is  reached. 

It  is  evident  that  the  modern  man,  particularly  in  this 
country,  is  more  sensitive  to  spirits  and  is  less  able  to 
throw  off  the  profound  toxaemias  manifest  in  stupor  and 
delirium.  It  is  also  clear  that  other  diseases  spring  up 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.     233 

more  readily  from  this  source  and  are  more  intense  and 
profound. 

The  condition  of  intoxication  resembles  that  of  a  shock 
and  suspension  of  the  normal  activities,  similar  to  that  of 
heat  or  sun  stroke,  or  hemorrhage,  in  which  local  conges- 
tion occurs.  This,  for  the  time  being,  is  very  intense,  but 
later  passes  off  and  the  functional  activities  become  nor- 
mal again. 

Careful  studies  of  brain  disease  show  that  traumata 
of  all  descriptions,  both  psychical  and  physical,  produce 
a  permanent  derangement  from  which  recovery  is  never 
certain.  Many  diseases  occurring  later  are  distinctly 
traceable  to  brain  injuries  which  were  considered  insig- 
nificant at  the  time. 

Intoxications  from  alcohol  are  both  toxaemias  and  trau- 
mata, in  which  poisoning  and  congestion  are  the  pathologi- 
cal conditions  present.  A  study  of  many  cases  show  distinct 
physical  degenerations  dating  from  the  first  intoxication. 
The  inference  is  clear  that  this  condition  is  by  no  means 
trivial  or  of  minor  importance,  no  matter  what  the  appear- 
ance may  be  afterwards.  The  brain  has  suffered  some  de- 
terioration from  which  it  never  recovered.  Hence  the 
medical  care  and  treatment  of  states  of  intoxications 
are  of  very  great  significance  and  should  require  the  most 
careful  study  and  remedial  measures. 

One  of  the  questions  which  present  themselves  is,  what 
are  the  probable  acute  exciting  causes,  and  how  can  they 
best  be  removed.  If  the  person  is  a  continuous  drinker,  and 
only  occasionally  poisoned  to  the  extent  of  delirium  and 
stupor,  the  case  is  one  of  accumulated  toxaemia.  Here 
the  poisons  are  introduced  from  without  and  formed  with- 
in the  body,  and  their  removal  is  the  very  first  effort  in 
the  treatment. 

If  the  person  is  a  periodic  drinker  with  distinct  free 
intervals  of  abstinence,  the  causes  which  precipitate  the 


INEBRIETY  . 


drink  storm  are  to  be  studied,  anticipated  and  prevented. 
Such  studies  indicate  a  great  variety  of  conditions  of 
which  poisoning,  congestion,  irritation,  general  and  local 
exhaustion  are  common. 

This  form  of  drinking  is  limited  and  controlled  by 
conditions,  not  always  recognized.  Removal  of  the  ex- 
citing causes  will  often  be  followed  by  a  sudden  cessation 
of  the  drink  impulse. 

In  certain  cases  the  approach  of  the  drink  paroxysm 
will  be  preceded  by  gormandizing  and  great  irregularity 
of  living.  In  others,  stupor,  depression  and  melancholia  ; 
in  others,  profound  exhaustion.  These  and  other  condi- 
tions are  to  be  recognized  and  treated  by  the  remedies 
which  seem  most  called  for. 

In  the  continuous  drinker  whose  toxic  conditions  create 
alarm,  profound  elimination  is  essential.  This  can  be  ac- 
complished by  one-tenth  grain  doses  of  apomorphia,  ad- 
ministered at  intervals  of  one  or  two  hours,  until  relaxa- 
tion, profuse  perspiration,  emesis  and  catharsis  follow. 

Warm  boths  with  vigorous  rubbing  and  reclining  in 
well  ventilated  rooms  are  essential  to  complete  recovery. 
Apomorphia  should  be  used  with  caution  because  of  the 
depressant  effect  which  follows.  Sometimes  this  is  so  pro- 
nounced as  to  contra-indicate  its  use.  Where  emesis  is 
called  for,  salt  water  and  ipecac  may  be  used  in  prefer- 
ence, as  safer  and  less  depressing. 

In  other  cases,  smaller  doses  of  apormorphia,  one-twen- 
tieth or  one-thirtieth  of  a  grain  may  be  given  for  its 
relaxing  and  sedative  effects.  These  suggestions  for  treat- 
ment have  particular  reference  to  cases  cared  for  at  home, 
or  calling  at  the  office. 

In  an  institution  where  the  surroundings  are  under  the 
control  of  a  physician,  the  medication  may  be  practically 
the  same,  but  the  condition  and  methods  of  treatment  will 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.     235 

vary.  Morphia  and  chloral  are  unsafe  narcotics  to  over- 
come the  insomnia  and  the  delirium  which  follow.  Chlo- 
ral should  never  be  used  because  of  its  accumulative  action, 
and  its  depressing  effect  on  the  vitality,  increasing  the 
delirium  and  prostration.  Opium  and  its  alkaloids,  mor- 
phia and  others  check  secretions,  and  favor  the  growth  of 
toxins  by  increasing  favorable  conditions  and  soils. 

Opium  extract  may  be  used  after  thorough  elimination 
has  taken  place  to  lessen  the  nerve  irritation,  but  it  should 
be  used  with  great  care  and  discretion.  Hydropathic 
means  and  measures  are  by  far  the  most  valuable  and  safe 
for  the  acute  stages  of  intoxication  and  the  conditions 
which  follow. 

Thus  persons  found  on  the  street  in  a  state  of  coma, 
exhaling  a  strong  spirit  odor,  should  never  be  given  spir- 
its, but  should  be  treated  with  hot  and  cold  water,  botn 
internally  and  externally.  Water  falling  in  a  small 
stream  on  the  back  of  the  neck  and  spine  is  a  powerful 
stimulant,  starting  up  the  heart  and  increasing  the  cir- 
culation. 

A  warm  bath  is  the  most  valuable  restorative  to  the  cir- 
culation and  the  congestive  conditions  that  are  present. 
Most  of  the  cases  calling  for  active  treatment  may  be  di- 
vided into  three  classes,  which  require  different  measures, 
particularly  in  the  after  treatment. 

First,  one  in  which  the  intoxication  has  followed  the 
drinking  of  large  quantities  of  spirits  in  rapid  succession, 
as  in  the  return  of  a  drink  paroxysm,  or  sudden  obsession 
with  or  without  any  particular  motive. 

Second,  where  spirits  have  been  used  in  small  quantities 
extending  over  a  long  time,  as  for  instance,  in  the  so- 
called  moderate  drinker,  who  suddenly  becomes  intox- 
icated, or  a  person  at  a  banquet  who  drinks  lightly,  then 
suddenly  becomes  stupid  and  maniacal. 


236  INEBRIETY. 

Third,  persons  who  are  called  temperate,  who  from 
some  unknown  cause,  suddenly  become  intoxicated,  or 
from  some  known  cause  use  spirits  to  great  excess. 

In  the  first  class  there  is  evidently  some  sudden  depres- 
sion and  disturbance  of  the  circulation,  followed  by  intense 
irritation  and  demand  for  relief.  The  excessive  use  of 
spirits  is  simply  to  drive  away  psychical  or  physical  pains. 

There  may  be  some  motive  or  reckless  abandon,  but 
there  is  always  a  mental  element  which  should  be  recog- 
nized. One  of  the  most  prominent  remedies  is  apomor- 
phia  by  the  needle  for  its  deterrent  and  eliminative  ac- 
tions. Then  saline  cathartics  and  baths  and  rest  in  the 
best  possible  surroundings. 

After  the  acute  effects  are  passed,  a  cautious  use  of  sul- 
phate of  strychnine  in  small  doses,  one-sixtieth  of  a  grain, 
and  noting  its  effects  and  the  toleration  of  the  system, 
will  be  found  valuable,  for  the  nerve  irritation.  Lupulin 
in  eight  or  ten  grain  doses  is  safe  and  has  no  depressing 
effect.  This  with  other  mild  sedatives,  if  required,  will 
answer  the  purpose. 

In  the  second  condition,  where  intoxication  is  the  cul- 
mination of  continuous  use  of  spirits,  apomorphia  should 
be  given.  If  its  action  is  particularly  depressing,  it 
should  be  used  only  at  long  intervals,  or  not  at  all. 

Cathartics,  diaeretics  and  sudarific  may  all  be  used  at 
intervals  with  excellent  results.  The  object  to  be  secured 
is  diversion  and  elimination.  After  the  acute  symptoms 
have  passed,  various  tonics  can  be  given ;  strychnine  and 
atropia  in  combination  are  two  of  the  best  drugs  most 
commonly  used,  one-sixtieth  of  the  former  and  one-two- 
hundredth  of  the  latter,  given  at  intervals  of  four  hours 
for  two  or  three  weeks. 

If  no  toxic  symptoms  follow  they  should  be  withheld 
for  a  week  or  two  and  then  resumed  again.  This  alterna- 
tion may  be  continued  for  several  months.  Other  means 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.      237 

and   measures   having  reference  to  local   conditions,   par- 
ticularly of  the  hydropathic  class  should  be  used. 

In  the  third  condition  where  intoxication  is  sudden,  un- 
usual and  not  clearly  the  result  of  any  particular  condi- 
tions preceding  it,  hydropathic  measures  should  precede 
all  others.  Elimination  by  cathartics,  and  possibly  mild 
sedatives  after  the  acute  symptoms  subside,  may  be  found 
useful. 

It  is  always  a  question  to  be  considered  whether  drugs 
by  the  needle  for  these  acute  conditions  are  safe;  also 
whether  they  should  not  be  abandoned  at  a  very  early 
day  for  their  mental  effect.  While  the  needle  is  a  very 
valuable  method  by  which  drugs  may  be  given,  there  is 
a  psychical  impression  that  should  be  recognized  and  con- 
sidered in  all  cases. 

Sedatives  in  these  various  conditions  are  only  valuable 
for  their  immediate  effects,  and  should  be  of  the  mildest 
class.  The}7  should  be  concealed  from  the  patient  largely, 
and  varied,  and  never  continued  any  length  of  time. 

Gastritis  is  a  very  common  condition  in  these  acute  affec- 
tions, and  can  be  most  successfully  treated  by  hydro- 
pathic measures.  Packs  and  fomentations  over  the  sur- 
face and  small  quantities  of  water  given  internally,  com- 
bined with  the  lucodescant  light  are  very  effective  remedies. 
A  great  variety  of  means  and  measures  have  been  urged, 
among  them  narcotics  which  should  be  given  with  great 
caution. 

The  use  of  spirits  and  milk,  while  sometimes  checking 
the  irritation,  is  not  safe,  and  should  not  be  followed  in 
any  routine  wa}7.  The  absolute  removal  of  spirits  in  any 
form  is  the  safest  and  most  certain  measure  of  relief. 
The  extreme  thirst  associated  with  gastritis,  calling  for 
water  and  cooling  substances  is  another  condition  requir 
ing  good  judgment,  and  adaptation  to  the  conditions 
present. 


238  INEBRIETY. 

Ice,  lime,  and  bi-carbonated  waters  in  small  quantities 
given  every  hour  are  grateful.  Sometimes  cold  tea  has  a 
sedative  action.  If  to  these  various  palliatives  are  added 
hot  and  cold  fomentations  over  the  stomach  and  along 
the  spine,  the  acuteness  of  the  symptoms  subside. 

The  patient  should  be  kept  reclining  in  bed  and  given 
no  food  for  some  little  time.  It  is  a  mistake  to  suppose 
that  liquid  foods,  when  retained,  are  healing  in  their 
effects.  The  stomach  needs  rest  and  lavation  by  water 
more  than  anything  else. 

The  stomach  symptoms  are  self-limited,  and  can  be 
easily  overcome  by  water  and  natural  means.  With  the 
functional  disturbances,  there  is  high  arterial  tension, 
anamia  and  nerve  irritability.  Strychnine  has  been  used 
at  this  time  with  very  good  effects  occasionally. 

Small  doses  of  codein  given  by  the  needle  are  also 
highly  praised.  Strychnine  combined  with  small  doses  of 
atropia  are  also  valuable  for  their  sedative  effects,  but 
care  should  be  exercised  to  discriminate  any  toxic  action 
which  it  may  have. 

The  question  of  nutrition  and  the  various  tonics  in- 
dicated, of  which  forms  of  iron,  phosphorus  and  soda  are 
most  commonly  used,  must  be  decided  with  the  conditions 
of  each  case.  Thus  a  patient  who  has  been  a  gormand 
and  eaten  irregularly  and  excessively  should  be  restricted 
to  a  very  limited  diet.  One  who  has  been  abstemious  and 
underfed  should  require  very  carefully  arranged  foods 
taken  at  short  intervals,  particularly  foods  that  are  easily 
assimilated. 

The  deranged  metabolism,  so  common  in  these  cases, 
must  be  recognized  in  the  questions  of  diet,  and  not  the 
patient's  appetite  for  food.  An  abnormal  appetite  after 
the  acute  symptoms  is  very  often  the  beginning  of  auto- 
intoxication which  will  end  in  relapse. 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.     £39 

Equal  care  of  the  diet  as  of  that  of  typhoid  fever, 
should  be  given  after  the  subsidence  of  the  acute  symp- 
toms. No  person  should  be  considered  cured  on  the  sub- 
sidence of  gastritis  and  other  toxic  symptoms.  The  fact 
that  the  patient  is  able  to  resume  his  customary  work  must 
not  be  considered  evidence  of  cure,  but  rather  an  indica- 
tion of  the  possibility  of  future  restoration  by  the  use 
of  rational  means  and  measures.  The  physician  should 
be  very  emphatic  in  urging  further  care  with  medical 
means  and  measures. 

Some  examples  will  make  these  facts  more  clear. 
Thus  a  man  with  an  alcoholic  heredity  who  was  an  ab- 
stainer up  to  thirty  years  of  age  suddenly  drank  to  grea* 
stupor  and  delirium.  The  active  causes  were  disappoint- 
ment in  business,  and  shock  at  pecuniary  losses.  The 
physician,  after  giving  thoroughly  eliminative  measures, 
began  a  course  of  restricted  diet  with  active  hydropathic 
measures,  impressing  the  patient's  mind  with  the  extreme 
gravity  of  his  condition. 

Bitter  tonics  were  given  at  first,  particularly  cinchona 
bark,  for  a  few  days,  and  then  abandoned  and  taken  up 
again.  He  was  able  to  resume  business,  but  followed  the 
directions  of  the  physician,  who  gave  very  active  treat- 
ment for  over  a  year. 

The  treatment  consisted  of  regular  baths,  exercise, 
tonics,  restricted  diet  and  regulation  of  his  work  an:! 
sleep.  The  recovery  was  complete,  and  although  the  phy- 
sician was  retained  for  many  years  and  consulted  on  every 
occasion,  the  patient  continued  temperate  until  his  death 
from  an  accident  many  years  after. 

Had  this  first  attack  of  intoxication  been  treated  with 
the  usual  narcotics  of  which  morphia,  chloral  and  other 
similar  remedies  are  most  common,  then  dismissed  with 
moral  advice  and  warnings,  relapse  would  certainly  have 
followed,  and  he  would  have  died  an  inebriate. 


240  INEBRIETY. 

A  similar  instance  was  that  of  a  teacher,  who  at  a  ban- 
quet was  urged  to  drink  various  kinds  of  spirits  and  sud- 
denly became  acutely  intoxicated.  The  physician  was 
called,  and  among  other  things  made  a  very  strong  im- 
pression on  the  patient's  mind  of  the  need  of  active  treat- 
ment and  unusual  care  both  in  diet  and  hygienic  measures. 

The  patient  recovered,  although  he  remained  under  the 
care  of  the  physician  for  a  long  time.  In  this  case,  had 
the  physician  given  the  usual  drugs  and  considered  the 
conditions  very  insignificant  and  transient  the  future 
would  have  been  doubtful. 

After  the  subsidence  of  the  acute  symptoms  a  degree  of 
remorse  may  come,  or  the  patient  may  have  egotistical 
confidence  that  the  toxic  state  was  of  minor  importance, 
and  was  a  mere  accident  from  which  recovery  is  absolutely 
certain,  and  relapse  will  never  occur  again. 

If  the  physician  who  is  called  will  recognize  this  mental 
attitude  and  impress  on  the  patient's  mind  the  serious- 
ness of  this  event  and  the  possible  danger  which  may  come 
from  it  in  the  future,  and  insist  that  he  come  under  med- 
ical care  and  direction,  the  most  gratifying  results  will 
follow. 

Persons  who  have  been  intoxicated  several  times,  and 
for  some  reasons  unknown,  call  in  the  physician,  should 
be  subjects  of  very  serious  inquiry  and  study.  The  pa- 
tient's judgment  of  his  own  case  should  not  be  accepted 
or  recognized,  but  the  fact  of  having  drunk  before  up  to 
intoxication  should  be  given  the  greatest  prominence. 

The  delusion  that  having  once  recovered,  he  can  do  so 
again,  is  a  very  serious  bar  to  preventive  measures.  The 
patient's  ego  must  be  overcome,  and  his  delusions  de- 
stroyed, and  in  most  cases  this  is  very  easily  done.  All  of 
these  cases  present  evidence  of  the  derangement  of  the 
liver,  kidneys,  heart  and  arteries,  and  disturbances  of  the 
digestion,  which  may  be  organic,  and  are  certainly  func- 
tional. 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES. 


A  periodic  drinker,  during  a  paroxysm  of  intoxication 
suffered  from  pericardial  pains  which  greatly  alarmed 
him.  The  physician  gave  a  very  serious  prognosis,  and 
impressed  upon  him  the  necessity  of  remaining  in  bed  and 
taking  active  treatment.  After  a  time  the  restoration 
came  on  and  with  it  delusions  of  strength. 

The  physician  and  friends  impressed  upon  him  the 
necessity  of  careful  medication,  hydropathic  and  nutrient, 
which  was  continued  for  over  two  years,  and  resulted  in 
the  complete  subsidence  of  the  drink  paroxysm  and  his 
final  recovery. 

In  another  example  a  lawyer,  who  after  intoxication 
sent  for  a  physician,  expecting  temporary  relief  and  res- 
toration which  had  been  received  many  times  before. 
The  physician  recognized  the  chronicity  of  his  case  and  im- 
pressed the  idea  that  he  was  on  the  borders  of  a  general 
paresis  in  which  his  recovery  was  doubtful. 

After  a  time  the  patient  grew  skeptical  and  doubted  the 
diagnosis.  A  consultation  was  called,  and  the  first  diag- 
nosis was  confirmed.  Then  he  consented  to  follow  the  pre- 
scribed course  of  treatment.  After  a  time  it  was  found 
that  he  was  using  beer  secretly.  The  physician  gave  him 
apomorphia,  the  effects  of  which  alarmed  him,  and  from 
this  he  continued  for  over  two  years,  receiving  medical 
care,  and  following  implicitly  the  directions  laid  down. 
He  recovered  and  was  a  total  abstainer  ever  afterwards. 

A  very  prominent  congressman  drank  to  great  excess 
at  intervals  and  called  in  eminent  professional  men  for 
relief  on  every  occasion.  At  one  time  he  became  intoxi- 
cated at  a  hotel  and  called  upon  an  obscure  physician 
who,  after  an  elaborate  examination,  suggested  the  neces- 
sity of  making  a  will  at  once,  and  urged  that  every  prep- 
aration should  be  made  in  the  possibility  of  sudden  death. 

The  will  was  drawn  and  the  patient  was  startled  and 
impressed  with  fears  which  the  physician  fostered  in  every 


INEBRIETY. 


way.      Very    close    attention    with    elaborate    medication, 
hydropathic  and  otherwise,  with  a  careful  study  of  every 
symptom,  and  this  was  kept  up  for  a  month  or  more,  be 
fore  the  patient  was  allowed  to  go  out  and  take  up  his 
duties. 

The  physician  continued  his  treatment  and  the  patient 
followed  directions  in  the  most  conscientious  way  for  two 
years  or  more.  His  recovery  was  complete.  This  man  is 
now  in  the  United  States  Senate,  doing  excellent  work 
and  thoroughly  temperate.  Other  physicians  had  treated 
him  for  the  drink  paroxysms,  probably  with  morphine, 
chloral  and  bromide,  with  warnings  and  counsels,  and  had 
recognized  his  own  judgment  concerning  cure  and  re- 
covery. 

These  examples  indicate  a  very  wide  field  in  which  the 
family  physician  can  give  most  substantial  and  valuable 
help  to  a  class  of  patients  whose  temporary  toxic  condi- 
tions are  never  treated  in  a  systematic  scientific  way. 

Numbers  of  active  business  men  are  driven  to  the  char- 
latan and  gold  cure  establishments  with  the  hope  of  re- 
ceiving some  permanent  help,  where  the  family  physician 
has  failed. 

Office  patients  who  come  to  the  physician  for  the  re- 
lief of  conditions  following  the  toxic  use  of  alcohol  are 
turned  off  with  a  prescription,  with  or  without  advice,  and 
are  neglected,  and  in  this  way  become  incurable.  They 
should  be  carefully  examined,  studied  and  treated  belli 
physically  and  psychically,  and  made  to  understand  the 
gravity  of  their  condition,  and  the  statements  of  the 
patient  and  their  friends  should  not  be  the  basis  of  a 
superficial  diagnosis  preventing  any  further  treatment. 

All  institutions  for  the  treatment  of  inebriates  present 
examples  of  the  failure  of  the  family  physician  to  under- 
stand and  give  the  first  aid  and  assistance  to  these  poor 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.     243 

wounded  victims,  who  later  become  incurable,  and  theu 
make  most  strenuous  efforts  to  recover. 

Often  inebriates  appeal  to  the  physician  for  help  in 
the  remorseful  stage,  suffering  from  the  depression  which 
follows  the  drink  paroxysm.  Often  they  exaggerate  their 
symptoms  and  give  most  gloomy  prognosis  in  the  future, 
and  come  to  the  physician's  office,  or  send  to  him  for 
help. 

Frequently  they  are  among  his  friends  and  patrons, 
and  when  not  using  spirits  are  most  attractive,  excellent 
citizens.  The  office  treatment  consists  usually  of  nar- 
cotics, tonics  and  placebos  with  threats  and  warnings  and 
appeals.  Often  the  appeal  is  for  medicine  to  neutralize 
or  break  up  the  drink  craze  which  the  physician  is  usually 
powerless,  or  fails  to  do  in  a  practical  way. 

If  the  physician  should  make  a  careful  study  of  these 
cases,  and  dismiss  all  thought  of  the  moral  theories  and 
the  patient's  ability  to  control  himself,  a  new  and  most 
fertile  field  of  practice,  and  successful  treatment  would  be 
found. 

The  appeals  for  help  to  break  up  the  drink  craze  are 
very  often  touching.  The  coarse,  crude  efforts  to  break 
up  the  drink  craze  often  intensify  the  debility  and  while 
stopping  the  craze  for  a  time,  cause  it  to  return  with 
greater  urgency  than  before. 

The  first  means  should  be  to  eliminate  the  toxins  by 
catharsis  with  salines.  Then  insist  that  the  patient  shall 
take  highly  concentrated  solutions  of  quassia,  or  cin- 
chona bark.  The  former  is  preferable,  because  it  can  be 
concentrated  by  repeated  boiling.  Give  two  ounces  of  this 
every  two  hours.  The  patient  may  use  spirits  or  not  ac- 
cording to  his  inclination. 

In  a  very  short  time  the  desire  for  spirits  disappears, 
and  a  repugnance  to  its  taste  and  smell  comes  on.  There 


244  INEBRIETY. 

seems  in  this  drug  to  be  an  antagonism  making  the  ef- 
fects of  the  spirits  painful,  and  later  followed  by  extreme 
disgust. 

If  the  patient  will  continue  this  quassia  after  the  dis- 
gust has  appeared  at  longer  intervals,  and  finally  when- 
ever the  desire  for  spirits  comes  back  follow  it  by  an 
ounce  of  quassia  mixture,  a  temporary  restoration  is  sure 
to  follow.  Cinchona  bark  produces  nearly  the  same  ef- 
fect, but  it  must  be  given  in  larger  doses  and  always  in 
solutions. 

Quinine  can  be  used,  but  cinchonism  comes  on  early 
and  with  it  little  or  no  revulsive  feeling.  Apomorphia 
may  be  used  occasionally,  but  only  in  particular  cases 
where  a  profound  relaxing  action  is  called  for.  These 
drugs,  in  most  cases,  will  effectually  break  up  the  drink 
craze  for  the  time  being,  and  enable  the  physician  to  de- 
termine what  further  measures  can  be  used  to  continue  the 
good  effects  and  overcome  the  abnormal  condition?  which 
demand  the  return  of  the  use  of  spirits. 

Examples  of  cases  that  have  been  permanently  restored 
by  temporary  office  treatment  are  as  follows:  A  noted 
politician  applied  to  a  physician  for  help  to  prevent  him 
from  drinking  during  an  exciting  convention  that  was  io 
occur  the  next  day. 

He  was  advised  to  take  large  quantities  of  concentrated 
quassia  solution  the  day  before  the  meeting,  and  drirk 
freely  of  mineral  water.  He  was  surprised  to  find  thnt 
all  drink  impulses  were  absent  and  in  their  place  a  strong 
repugnance  for  the  odor  of  spirits. 

He  was  able  to  do  his  work  with  great  satisfaction,  ar.d 
later  came  under  the  care  of  a  physician  for  treatment 
and  became  a  total  abstainer. 

Another  man  equally  noted  applied  for  help  to  prevent 
intoxication  ,at  the  annual  banquet  of  his  college  society. 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.     245 

The  same  treatment  was  given  with  the  addition  of  oue- 
two-hundredth  of  a  grain  of  sulphate  of  atropia  every 
four  hours  for  two  days  before  the  banquet. 

His  experience  was  so  satisfactory  that  he  placed  him- 
self under  the  charge  of  the  physician  and  eventually  be- 
came a  total  abstainer. 

A  third  case  was  that  of  a  lawyer,  who  at  the  close  of 
a  long  exciting  trial,  when  worn  and  exhausted,  drank  to 
excess.  So  frequently  did  this  occur  that  he  went  off  to  a 
watering  place  and  remained  concealed  until  the  drink 
storm  went  by. 

He  was  placed  on  the  quassia  treatment  and  was  able  to 
overcome  the  impulse  to  drink.  Then  by  baths  and  pro- 
longed rest,  recovered  and  was  a  total  abstainer  the  rest 
of  his  life. 

A  very  interesting  case  is  reported  by  a  physician,  of 
a  delusional  inebriate  who  confided  to  the  physician,  that 
during  the  drink  paroxsym  he  was  sorely  tempted  to  kill 
his  wife,  child  and  himself,  and  on  several  occasions  was 
only  deterred  from  committing  the  act  by  a  slight  cir- 
cumstance. 

Later  he  was  horrified  at  this  insane  impulse  and  ap- 
pealed to  the  physician  for  help.  After  a  dose  of  apo- 
morphia,  followed  by  baths  and  active  treatment,  he  was 
given  strychnine  and  atropia,  and  urged  to  come  to  the 
physician  when  he  began  to  feel  the  drink  impulse  coming 
on.  He  did  so  and  was  given  large  quantities  of  quassia, 
which  quickly  overcame  the  impulse.  This  was  repeated 
several  times  during  the  course  of  the  year  and  was  fol- 
lowed by  a  complete  recovery. 

The  possibilities  of  relief  and  assistance  in  these  par- 
oxysmal drink  obsessions  are  almost  unlimited,  and  open  a 
new  field  of  practice,  that  is  at  present  practically  un- 
known. 


246  INEBRIETY. 

Examples  of  failures  of  physicians  to  give  this  first  aid 
to  the  wounded  or  rather  to  assist  the  patient  to  over- 
come the  drink  obsession  may  be  noted  in  the  following, 
Avhich  are  common  in  the  practice  of  almost  every  physi- 
ician. 

A  banker  appealed  to  his  physician  for  help  to  over- 
come the  desire  for  spirits,  which  he  feared  was  growing 
and  destroying  his  physical  and  business  interests.  The 
physician  gave  bromides,  chloral  and  various  other  seda- 
tive remedies,  together  with  the  tincture  of  cinchona. 

He  failed  to  realize  that  cinchona  as  a  tincture  contain- 
ing a  large  quantity  of  alcohol  was  a  very  dangerous 
remedy.  Finally,  in  despair,  he  sent  the  banker  to  a 
quack  cure.  A  few  weeks  later  he  returned  buoyed  up 
with  the  faith  that  he  was  permanently  cured.  Later  he 
relapsed  and  became  a  secret  drinker. 

A  few  years  afterwards  he  was  convicted  of  forgery 
and  sent  to  prison  for  ten  years. 

A  prominent  clergyman  who  drank  for  exhaustion,  real- 
izing the  danger,  called  in  the  family  physician.  A  great 
variety  of  remedies  were  used.  Little  or  no  attention  was 
paid  to  the  real  conditions.  The  patient  failed  to  get 
permanent  relief.  Later  became  a  drug  taker  and  finally 
after  a  sensational  exposure  he  committed  suicide. 

These  cases  might  be  multiplied  to  an  almost  indefinite 
extent.  It  may  be  said  that  there  are  an  increasing  num- 
ber of  persons  in  every  town  and  city  who  are  becoming 
alarmed  at  their  inability  to  break  up  the  drink  impulse 
and  stop  the  use  of  alcohol. 

They  go  to  the  family  physician  for  help,  and  failing 
to  get  any  particular  satisfaction  or  assistance,  resort  to 
patent  drugs  and  gold  cures,  and  later,  in  desperation,  go 
to  some  hospital  or  sanatorium.  They  realize  their  dan- 
ger and  have  a  dim  impression  that  something  might  be 
done  to  keep  them  from  growing  worse.  The  physician, 


HOME  AND  OFFICE  TREATMENT  OF  INEBRIATES.     247 

who  of  all  others,  should  be  their  best  guide  and  counst1, 
fails  to  realize  the  seriousness  of  their  condition,  and  en- 
courages the  theory  that  it  is  a  moral  weakness  which  they 
should  overcome,  and  thus  unconsciously  drives  the  patient 
away. 

Office  treatment  of  persons  suffering  from  drink  par- 
oxysms, who  are  given  morphia,  chloral  and  other  sedatives, 
has  many  perils.  The  physician  recognizing  the  present 
symptoms  without  particular  reference  to  their  causes  or 
conditions,  may  give  morphia  or  some  other  narcotic. 
The  patient  goes  home,  uses  more  spirits  and  dies. 

Should  any  question  be  raised,  the  prescription  shows 
that  the  dose  was  correct  as  to  size,  and  other  conditions 
are  supposed  to  account  for  the  death.  A  number  of 
cases  have  come  into  prominence  in  which  a  small  dose  of 
morphia  or  chloral  has  been  fatal. 

The  depressed  brain  and  nervous  system  were  not  rec- 
ognized, and  the  narcotic  given  still  further  paralyzed  the 
vital  centers. 

A  case  of  some  prominence  in  which  a  paroxysmal 
drinker  was  given  a  quarter  of  a  grain  of  morphia,  hypo- 
dermically,  and  fifteen  grains  of  chloral  to  be  taken  on 
retiring.  Death  followed,  and  a  legal  contest  grew  out 
of  this. 

The  physician  was  sustained  by  the  courts,  but  in  all 
probability  a  better  acquaintance  with  the  patient  and 
the  conditions  from  which  he  was  suffering  would  have  led 
him  to  give  other  drugs,  and  the  patient  would  have  lived. 

Office  prescriptions  which  are  eliminative  are  safe,  and 
solutions  of  bitters  and  salts  can  be  used  with  great  effi- 
ciency, but  such  patients  should  always  be  under  the  ob- 
servation of  physicians  and  never  neglected,  but  seen 
often. 

Office  and  home  treatment  can  be  most  successfully 
carried  on,  if  the  physician  can  secure  the  hearty  sym- 


248  INEBEIETY. 

pathy  and  confidence  of  the  patient  and  his  family. 
Where  the  inebriety  is  continuous,  the  conditions  are  more 
complex  and  require  more  careful  study. 

If  the  patient  is  a  periodic  inebriate  a  great  variety  of 
conditions  must  be  understood,  before  exact  treatment  c,":n 
be  made  successful. 

In  the  numerous  classes  of  drinkers,  dependent  on  the 
great  variety  of  surroundings  and  active  and  remote 
causes,  there  are  always  certain  indications  which  will 
show  how  far  home  and  office  treatment  can  be  successful, 
and  when  and  where  home  and  institutional  treatment 
should  be  substituted. 

The  empiric  efforts  to  cure  the  chronic  cases  and  these 
who  have  reached  terminal  stages  by  reason  of  protracted 
poisoning  and  degenerations  extending  over  years,  are 
very  startling  in  their  temporary  successes,  and  occasional 
permanent  restoration. 

The  methods  used  are  exceedingly  coarse  and  unscien- 
tific, and  yet  the  effects  and  impressions  produced  are 
very  marked.  It  is  evident  that  there  is  a  wide  field  of 
therapeutic  possibilities  that  is  unoccupied  at  present,  in 
which  both  physical  and  psychical  remedies  can  be  con- 
centrated to  restore  and  permanently  cure  patients  by 
both  office  and  home  treatment. 


CHAPTER  XXIV. 

INSTITUTIONAL  TREATMENT    OF  INEBRIATES. 

Synopsis —  The  hospital  idea  of  treatment  very  old.  The  first 
care  on  the  Nile.  The  first  efforts  to  protect  drinking  men.  The 
first  hospital  began  in  1864,  at  Binghamton,  N.  Y.  The  advanced 
methods  promoted  there.  Controversy  over  these  plans.  First 
inmates  incurables.  Mentally  disturbed.  Discussions  over  dif- 
ferent methods.  Four  classes  of  hospitals.  One  doing  Govern- 
ment Work,  taking-  care  of  the  incurables,  struggling  with  the 
same  obstacles  that  confronted  Binghamton  Asylum.  A  second 
class,  both  corporate  and  private,  treating  patients  according  to 
the  original  plan  of  disease.  A  third  class  only  recognize  the 
moral  side  and  treat  that  alone.  A  fourth  class  claim  specific 
cures.  The  first  class  under  the  charge  of  the  Government  house 
patients  of  all  grades.  The  second  class  study  patients  scientif- 
ically. The  character  of  the  patients  which  come  to  these  hospi- 
tals. The  necessity  of  hospital  treatment.  The  possibility  of 
recovery.  This  treatment  precedes  all  others  as  a  necessity  in 
their  care  and  control.  The  whole  subject  is  yet  in  its  infancy. 
It  is  impossible  at  present  to  do  more  than  educate  the  public 
and  patients  to  realize  the  necessity  of  such  treatment. 

The  idea  of  gathering  inebriates  in  a  certain  place  for 
special  treatment  is  a  very  old  one.  Ulpian,  the  Roman 
jurist,  after  affirming  that  inebriates  were  diseased,  de- 
clared that  they  should  be  treated  in  special  surroundings 
and  buildings. 

Later  one  of  the  kings  of  Spain  announced  that  inebri- 
ates should  be  treated  in  special  places  as  sick  and  d's- 
eased.  In  one  of  the  tombs  of  Memphis  there  is  a  state- 
ment that  the  occupant  had  set  apart  a  building  for  the 
care  of  persons  overcome  by  wine  and  beers,  and  that  he 
ministered  to  them  such  means  as  would  relieve  them  from 
the  effects  of  spirits.  This  was  practically  a  hospital 
and  was  the  first  of  which  we  have  any  record. 

On  another  tomb  is  an  inscription  of  a  charitable  man 
who  provided  a  place  where  the  temple  worshipers  under 
the  influence  of  wine  could  be  taken  and  protected  until 
they  were  able  to  go  home. 

249 


250  INEBRIETY. 

From  other  sources  the  fact  is  stated  that  the  temple 
worshipers  who  became  practically  intoxicated,  in  par- 
taking of  the  offerings  given  to  the  dead,  were  carried  out 
on  the  banks  of  the  river  Nile  to  sleep  off  the  fumes  of 
the  spirits. 

This  was  found  to  be  dangerous  because  of  the  croco- 
diles which  came  out  of  the  river  and  devoured  them. 
Laws  were  passed  that  persons  who  became  stupid  from 
drink  were  to  be  put  into  separate  places  where  they 
could  be  protected. 

Several  references  are  made  in  those  early  records  of 
the  need  of  taking  care  of  the  persons  who  were  ov».r- 
come  by  spirits.  In  the  early  part  of  the  eighteenth  cen- 
tury hospitals  and  institutions  were  mentioned  as  giving 
the  best  means  for  their  care  and  protection. 

It  was  not  until  1864*  that  a  distinct  hospital  was 
opened  for  the  medical  treatment  of  inebriates  at  Bing- 
hamton,  New  York.  Lodging  houses  for  drinking  men 
were  opened  in  the  earty  part  of  1850.  Many  of  them 
were  rooms  over  saloons,  and  places  in  the  neighborhood 
of  hotels  where  persons  could  be  protected  and  cared  for. 

In  London  proprietors  of  saloons  advertised  very  cheap 
spirits  and  rooms  with  clean  straw  where  persons  over- 
come by  spirits  could  recline.  The  early  temperance  soci 
eties,  particularly  after  1840,  organized  lodging  houses 
which  were  practically  institutions  for  protection,  care 
and  such  treatment  as  was  needed.  There  are  several 
references  in  the  early  history  of  the  temperance  move- 
ment to  the  aid  received  from  physicians  in  these  places, 
which  was  literally  the  first  hospital  care,  or  first  aid  to 
the  wounded. 

Dr.  J.  E.  Turner,  the  founder  of  the  Binghamton  as\T- 
lum,  gave  the  first  clear  conception  of  the  hospital  work 
and  treatment  of  inebriates.  He  urged  that  inebriates 
were  in  the  first  stages  of  dementia  and  paresis  and  that 


INSTITUTIONAL  TREATMENT  OF  INEBRIATES.     251 

nothing  less  than  one  year  of  absolute  restraint  and  care- 
ful medical  observation  and  treatment  would  be  of  any 
value. 

The  hospital  at  Binghamton  was  founded  on  this  idea. 
It  required  no  pledges  or  promises,  but  simply  insisted 
that  the  patient  should  come  under  absolute  control  and 
care,  and  all  his  surroundings  be  regulated  on  a  fixed  mil- 
itary plan. 

Drugs,  baths,  exercise,  together  with  lectures  and  every 
physical  and  psychical  means  known  at  that  time  were  to 
be  used  in  the  treatment.  Work  in  shops  and  light  farm 
labor  were  given  to  all  who  accepted  them  as  a  means 
of  treatment. 

This  was  so  far  ahead  of  the  public  sentiment  of  thac 
day  that  the  protests  of  the  patients  against  the  restraint 
and  the  theory  of  disease  were  encouraged,  and  many 
means  were  sought  to  discredit  and  oppose  in  every 
way.  From  the  very  opening  of  the  institution  until  it 
was  changed  to  an  insane  asylum  sixteen  years  later  there 
was  a  constant  conflict  between  the  patients  and  the  man- 
agement, in  which  often  the  friends  of  the  patients  joined 
with  bitterness. 

The  founder,  Dr.  Turner,  insisted  that  the  inebriate 
was  diseased  and  needed  long  careful  treatment  with 
restraint  and  exercise  to  become  permanently  cured.  On 
the  other  hand,  the  patients  and  friends  urged  tint 
though  disease  might  be  present,  it  was  transient  and  re- 
covery depended  largely  upon  freedom  from  restraint  ar,d 
every  irritating  cause,  and  appeals  to  the  honor  aiid 
promises  of  the  patients. 

Many  papers  were  written  at  that  time  showing  the 
disease  was  that  of  the  will  power  in  which  manhood  and 
pride  were  more  largely  concerned,  and  that  all  restraint 
was  depressive  and  appeals  to  the  honor  were  stimulating. 
The  various  superintendents  of  the  Binghamton  asylum 


252  INEBRIETY. 

who  followed  Dr.  Turner  attempted  to  find  a  middle 
ground  for  treatment,  in  which  the  disease  theory  requir- 
ing restraint,  and  the  failure  of  the  will  power  needing 
freedom,  and  appeals  to  the  honor  and  pride  could  be 
combined.  They  all  failed.  Attempts  to  make  the  hos- 
pital popular,  not  only  increased  the  discontent,  but 
brought  with  it  an  element  of  personality  which  was  de- 
scribed as  personal  favors  or  persecution,  and  with  this 
came  the  political  element  which  increased  the  discontent 
and  brought  about  a  dismal  failure  of  plan  and  pur- 
pose. 

The  principle  upon  which  the  hospital  was  founded  was 
so  combined  with  moral  theories,  and  so  impracticaliy 
worked  out,  that  the  institution  was  finally  declared  a 
failure.  The  dogmatism  and  intense  ignorance  of  many 
good  men  of  that  day  illustrate  clearly  the  obstacles 
which  every  new  truth  must  pass  through,  and  the  con- 
troversy about  the  management  of  the  hospital  at  Bing- 
hamton  sounds  like  the  quarrels  of  little  children  at  this 
day. 

Physicians,  clergymen,  politicians  and  editors  wrote 
and  talked  about  the  treatment  of  inebriates  with  a  fa- 
miliarity and  confidence  that  was  startling.  Notwithstand- 
ing the  confusing  efforts  of  the  various  managers  to 
please  the  public  and  the  inmates  of  the  institution,  they 
unconsciously  exemplified  and  worked  out  many  of  the 
facts  which  are  now  being  recognized  as  the  most  ad- 
vanced principles  of  treatment. 

It  is  evident  that  the  early  work  of  this  institution  and 
the  theories  of  Dr.  Turner  will  be  studied  with  increasing 
interest  in  the  future.  A  number  of  institutions  were 
opened  for  the  reception  of  patients  in  different  parts  of 
the  country,  during  the  first  ten  years  of  the  existence  of 
the  asylum  at  Binghamton. 


INSTITUTIONAL  TREATMENT  OF  INEBRIATES.     253 

Nearly  all  of  them  grew  out  of  the  enthusiasm  arrl 
possibilities  which  the  institution  at  Binghamton  prom- 
ised, and  failed  for  want  of  knowledge  of  the  character 
of  the  patient  and  the  correct  principles  of  treatment. 
Other  institutions,  founded  on  some  special  view  of  what 
inebriety  was  and  was  not,  were  opened  gradually  chang- 
ing and  evolving  or  dying  out. 

At  present  there  are  four  classes  of  institutions  which 
may  be  said  to  represent  the  infancy  of  the  work.  Fits! 
and  most  prominent  are  the  state  and  county  institutions., 
incorporated  and  receiving  state  aid,  also  fixed  fees 
per  week,  for  the  patients  treated.  Laws,  giving  power  of 
holding  these  persons,  with  efforts  to  furnish  some  occu- 
pation, are  provided. 

The  general  principle  recognized  is  that  the  inebriate 
is  diseased  and  to  a  degree  irresponsible,  and  in  that  way 
he  is  a  semi-insane  man.  These  institutions  are  strug- 
gling with  the  same  obstacles  which  the  asylum  at  Bing- 
hamton encountered. 

The  managers  and  superintendents  are  constantly 
changing  from  political  and  other  causes.  Theories  of  all 
descriptions  and  plans  of  treatment  are  urged  and 
dropped  with  startling  frequency.  There  is  no  standard 
to  guide  them,  and  no  fixed  principles,  hence  they  belong 
to  a  reformatory  class.  Happily  they  are  steadily  evolv- 
ing towards  a  larger  knowledge  of  the  subject,  and  a 
clearer  conception  of  what  is  required. 

A  second  class  of  hospitals,  both  corporate  and  private, 
is  struggling  with  the  same  problem.  The  management 
is  based  on  the  theory  that  inebriety  is  half  disease  aiul 
half  vice ;  that  patients  are  irresponsible,  to  some  degree, 
while  drinking,  and  at  all  other  times  are  sane. 

Some  of  these  institutions  receive  mental  cases  and 
persons  who  are  eccentric  and  have  feeble  minds  and 


INEBRIETY. 


bodies.  Most  of  the  insane  asylums  have  wards  for  the 
inebriates,  in  which  the  disease  is  recognized  and  restraint 
applied  for  temporary  periods.  Beyond  that  there  is  no 
recognition  of  debility  or  disease. 

A  few  private  hospitals  exist  where  inebriates  are 
treated  exclusively  as  diseased,  following  the  theories  of 
the  great  founder,  Dr.  Turner,  in  which  remedies  of  all 
grades  and  degrees  are  applied,  and  the  patient  is  recog- 
nized as  both  organically  and  functionally  diseased,  and 
the  treatment  is  a  continuous  effort  to  build  up  and  restore 
him  to  healthy  living  again. 

A  third  class  of  hospitals  formerly  quite  numerous, 
now  almost  extinct,  ignore  all  questions  of  disease,  regard- 
ing the  patient  as  a  moral  dement,  who  happens  to  be 
poisoned  with  alcohol,  and  when  this  is  removed  the  real 
remedy  is  the  pledge,  the  prayer  and  appeals  to  his 
higher  will  power.  Some  of  these  institutions  have  fur- 
nished remarkable  examples  of  suggestion,  psychical  im- 
pressions and  possibilities  of  treatment,  along  lines  un- 
known before. 

A  fourth  class  of  hospitals  which  began  in  a  small  way 
soon  after  the  advent  of  Binghamton  Asylum  claimed  to 
have  discovered  some  specific  remedies  and  methods  of 
cure.  They  are  promoted  very  largely  by  irregulars  ard 
men  without  training  or  reputation,  and  depend  upon 
their  cxtraodinary  pretentions  and  startling  assertions. 

A  few  years  ago  they  attained  great  prominence,  but 
latterly  they  have  declined.  They  require  no  laws  of  re- 
straint and  seem  to  depend  entirely  on  the  ability  of  the 
patient  to  pay  the  fee  charged. 

These  four  general  classifications  describe  the  institu- 
tional work  for  the  treatment  of  inebriates  at  present. 
The  first  class  managed  by  the  state  and  county  officials 
are  the  most  hopeful  and  are  probably  doing  the  b?3t 


INSTITUTIONAL  TREATMENT  OF  INEBRIATES.     255 

work,  although  the  inmates  are  almost  altogether  of  the 
chronic,  incurable  classes. 

Their  work  of  housing  and  controlling  them  gives  an 
opportunity  for  study  which  will  be  taken  advantage  of 
in  the  future.  The  inmates  committed  by  law  are  to  some 
extent  provided  with  occupation  and  this  appeals  to  the 
taxpayer,  not  only  in  removing  the  patient  from  the 
community,  but  relieving  the  burdens  which  fall  upon  the 
family. 

There  is  every  reason  to  hope  that  these  institutions 
will  make  their  inmates  more  or  less  self-supporting  as 
well  as  to  restore  a  certain  percentage  to  normal  living 
again. 

The  private  corporate  hospitals,  depending  upon  the 
income  from  patients  for  their  existence,  are  stimulated  to 
discover  and  combine  all  means  possible  to  bring  about 
restoration.  Their  particular  purpose  is  to  concentrate 
all  the  known  remedies  and  measures  for  curing  the  vic- 
tim and  preventing  him  from  future  relapse. 

The  most  advanced  study  and  work  is  to  be  expected 
from  these  institutions,  because  of  the  stimulus  and  in- 
centive to  attract  patients  and  produce  permanent  results. 
The  State  of  Connecticut  has  a  most  advanced  law, 
giving  private  incorporate  hospitals  legal  control  over 
the  inmates.  Other  States  have  limited  restrictions  which 
will  be  greatly  improved  in  the  near  future. 

Hospitals  and  insane  asylums  with  special  wards  for 
the  treatment  of  acute  cases  of  this  class  are  becoming 
more  and  more  available  and  give  very  substantial  aid  and 
help.  Much  depends  upon  the  attitude  of  friends  and 
relatives  who  permit  the  patient  to  go  home  long  before 
he  is  cured. 

The  egotism  and  irritation  and  evident  dementia  of 
the  patient  after  the  subsidence  of  the  acute  symptoms 


256  INEBRIETY. 

are  not  recognized.  A  very  large  class  of  persons  who 
come  for  treatment  to  hospitals  are  in  the  terminal  in- 
curable stages.  They  are  credulous,  emotional  neurotics 
who  have  tried  all  sorts  of  means  and  remedies  without 
success,  and  in  the  remorseful,  period  after  the  removal 
of  spirits,  grasp  at  every  new  hope  and  new  expectation 
for  permanent  restoration.  Later  they  consider  them- 
selves cured  and  are  very  insistent  on  returning  to  their 
home  life  and  circles  again.  When  they  relapse  the 
hospital  and  its  management  are  considered  responsible. 

A  certain  percentage  of  these  inebriates  are  moral 
paralytics  and  create  great  expectation  and  enthusiasm, 
among  their  friends,  pertaining  to  their  cure,  and  often 
pose  as  examples  of  the  extraordinary  work  done  in  the 
institution,  or  by  secret  remedies. 

Later,  when  they  relapse,  they  seem  to  take  malicious 
pleasure  in  condemning  the  hospital  and  the  means  used 
in  their  former  treatment.  Public  sentiment  is  always  in- 
fluenced more  or  less  by  these  relapsed  patients  whose  vo- 
ciferous declarations  of  failures  or  successes  in  hospitals 
are  regarded  as  evidence  of  the  real  condition. 

In  this  class  of  hospital  patients  are  the  great  army 
of  border  liners,  including  the  psychopaths,  paranoiacs 
and  degenerates  in  the  first  stages  of  insanity.  There  is 
another  class  of  inmates  becoming  more  numerous  every 
year,  who  frequent  these  hospitals.  They  are  the  brain 
exhausted,  practically  worn  out,  men  and  women  who  use 
alcohol  as  a  narcotic  to  cover  up  the  pains  and  discom- 
forts from  which  they  suffer,  and  to  enable  them,  in  some 
slight  measure,  to  continue  amidst  the  changing  conditions 
of  life. 

This  class  patronize  the  quack  hospitals  largely,  at- 
tracted by  the  prctentions  and  promises  of  rapid  per- 
manent cure.  Later  they  go  to  better  organized  institu- 


INSTITUTIONAL  TREATMENT  OF  INEBRIATES.     257 

tions  and  accept  the  restraint,  receive  scientific  care  and 
utilize  the  methods  offered,  in  a  rational  business-like 
spirit. 

Many  such  persons  recover.  After  the  subsidence  of 
the  acute  symptoms,  the  restraint  of  the  hospital,  of  the 
surroundings  and  the  physical  conditions,  are  accepted  as 
necessities  and  made  available  to  the  fullest  extent.  Such 
persons  never  pose  as  examples  of  cures,  but  go  back  to 
private  life  without  making  any  reference  to  this  treat- 
ment or  its  necessity. 

The  impression  prevails  that  it  leaves  a  stigma  to  be 
obliged  to  take  such  treatment,  hence  it  is  not  mentioned 
in  later  life.  All  well  organized  institutions,  doing  legiti- 
mate work,  have  lists  of  persons  restored,  who  never  refer 
to  the  institution  or  their  treatment,  for  this  reason. 

Another  class  of  patients  are  continuously  extolling  or 
condemning  such  institutions,  and  referring  to  their  ex- 
perience with  suspicious  volubility. 

There  is  another  class  to  whom  the  hospital  is  a  city 
of  refuge.  Such  persons  recognize  their  need  of  help  ar.d 
go  for  treatment  either  openly  or  secretly.  Some  of  them 
are  paroxysmal  drinkers  who  go  to  break  up  the  pai- 
oxysm,  for  the  correction  of  some  local  affection  or 
rest  from  certain  nerve  exhaustion. 

The  great  hotel  sanitoriums  of  this  country  and  Eu- 
rope have  a  very  large  number  of  persons  who  are  moder- 
ate or  excessive  drinkers  and  who  realize  in  a  slight  degree 
the  danger  of  their  present  condition,  and  seek  medics  1 
help.  Some  of  the  more  modern  names  of  nervous  dis- 
eases are  literally  degenerations  and  disorders  from  al- 
cohol. 

At  these  institutions  sanitorium  methods  and  remedies, 
such  as  baths,  electricity  and  massage  are  very  effective 
and  wise  physicians  recognizing  the  real  causes  urge 


258  INEBRIETY. 

abstinence  from  spirits  and  other  exciting  causes.  Most 
of  these  patients  come  to  organized  hospitals  after  a  time 
and  secure  exact  scientific  care. 

Institutional  care  of  inebriates  is  thus  built  up  slow1y 
from  sanitoriums  and  other  places  where  seclusion  and  rest 
can  be  had.  Institutional  care  with  its  change  of  sur- 
roundings and  living,  its  military  conditions  of  life,  divu- 
sions  for  the  brain  and  nervous  system,  together  with  spe- 
cial appliances  for  this  particular  condition,  is  a  necessity 
that  is  growing  constantly. 

The  late  Dr.  Mott  always  referred  to  the  inebriate  as 
one  with  a  fractured  brain  and  nervous  system,  requiring 
the  splint  and  bandage  of  an  institution.  This  figure 
describes  in  a  very  suggestive  way  many  of  the  conditions 
essential.  Institutional  treatment  is  literally  placing  the 
patient  in  a  condition  where  his  malady  can  be  studied 
and  better  understood  than  elsewhere,  and  also  where  the 
application  of  means  and  measures  can  be  concentrated 
and  made  to  promote  restoration  with  a  degree  of  certain- 
ty not  possible  elsewhere. 

Experience  has  shown  that  a  certain  number  of  persons 
find. in  hospitals  both  a  physical  and  psychical  help  which 
cannot  be  obtained  elsewhere.  Many  of  the  older  institu- 
tions have  a  class  of  patients  who  come  regularly  at  inter- 
vals for  the  security  which  the  hospital  offers. 

They  come  suffering  from  excitement  and  exhaustior  ; 
often  associated  with  the  use  of  spirits  or  marked  by  an 
intense  dread  and  fear  of  drinking  again.  Common  ex- 
amples are  that  of  a  lawyer  who  many  years  ago  drank 
to  excess ;  then  recovered.  At  irregular  intervals  he  comes 
to  the  hospital,  takes  baths,  rests  a  few  days  and  then 
goes  away.  The  relief  which  the  institution  gives  him 
and  the  psychical  security  of  removal  from  temptation 
brings  about  a  rest  and  restoration. 


INSTITUTIONAL  TREATMENT  OF  INEBRIATES.     259 

A  physician  who  has  an  obsession  that  if  he  drank 
spirits  he  would  kill  his  family  and  himself,  comes  to  ail 
institution  to  prevent  him  from  drinking.  He  does  not 
drink,  but  he  is  frightened  at  the  prospect  of  tempta- 
tion. The  moment  he  reaches  the  institution  his  fears 
dissolve  and  later  he  returns,  quiet  and  normal  in  every 
way. 

Other  persons  come  to  the  institution  after  having 
drunk  and  committed  overt  acts.  They  are  filled  with 
the  sense  of  danger,  and  are  led  to  make  tremendous 
efforts  to  avert  it. 

The  same  conditions  are  noted  in  the  better  class  of 
Turkish  baths  in  large  cities.  Here  can  be  seen  persons 
recovering  from  drink  paroxysms  and  others  who  are  en 
the  verge  of  drinking,  taking  prolonged  baths  and  be- 
coming fully  restored. 

Sanitoriums  at  mineral  springs  have  many  persons  of 
this  class,  who  drink  largely  of  the  waters,  take  the  baths, 
and  not  only  expect  but  receive  temporary  help  and  resto- 
ration. A  certain  hospital  in  one  of  the  large  eastern 
cities  has  a  number  of  rooms  with  barred  windows,  set 
apart  for  persons  who  are  in  the  delirious  stage  of 
inebriety. 

Many  persons  come  from  the  higher  walks  of  life,  and 
ask  to  be  admitted  and  put  under  restraint  so  they  can 
overcome  the  delirious  impulse  to  drink.  Institutional 
treatment  does  more  than  provide  restraint  and  protection. 
Where  they  are  properly  managed  the  patient  can  be 
educated  and  taught  to  understand  his  condition,  and  to 
know  the  danger  signals,  and  provide  for  them  in  the 
future. 

He  is  trained  to  interpret  correctly  some  of  the 
phenomena  of  his  condition  and  to  realize  the  particular 
effect  from  distinct  causes,  and  in  this  way  he  has  a  new 


260  INEBEIETY. 

comprehension  of  his  condition  and  the  dangers  which 
beset  him.  In  a  well  ordered  institution  this  education 
and  mental  training  has  a  very  pronounced  value  to  most 
patients. 

In  some  of  the  larger  institutions  talks  and  experience 
meetings  are  conducted  by  the  patients,  in  which  different 
views  are  given  and  impressions  made  that  are  very  help- 
ful. Where  the  physician  seeks  to  break  up  the  delusions 
of  the  patient  by  private  talks  or  lectures,  and  calls  atten- 
tion to  the  facts  of  his  condition  and  the  needs  of 
clearer  recognition,  he  is  really  giving  treatment  that  has 
a  peculiar  value,  although  not  often  recognized. 

All  the  institutions  doing  scientific  work  should  give 
prominence  to  these  psychical  forces,  and  seek  to  direct 
the  patient  along  lines  of  healthy  thought  and  living. 
This,  combined  with  other  measures  and  means,  consti- 
tute the  highest  kind  of  scientific  modalities  that  can  be 
used. 

There  can  be  no  question  that  institutional  treatment 
of  inebriates  will  occupy  a  very  large  place  in  the  future, 
also  that  home  and  office  treatment  will  be  preliminary  or 
furnish  the  after  care  so  essential.  The  need  of  isola- 
tion, change,  forced  rest  and  concentration  of  special 
means  and  measures  adapted  for  these  psychoses,  is  be- 
coming more  and  more  recognized. 

Some  objectors  claim  that  certain  persons  are  impressed 
that  no  help  can  be  had  outside  of  a  hospital,  and  for  all 
sorts  of  mental  and  physical  disturbances  they  turn  to 
the  hospital  for  relief.  This  may  be  true  in  some  measure, 
but  in  the  psychosis  of  inebriety  it  can  never  be  an 
abuse. 


CHAPTER  XXV. 

THE  STATE  CARE  AND  TREATMENT  OF  INEBRIETY. 


Synopsis.  —  Inebriates  seldom  recognized  until  they  reach  chronic 
stages.  Such  persons  are  frequently  dependent  on  their  friends. 
The  state  will  not  help  them  unless  they  have  become  dependent 
and  paupers.  The  assumption  is  that  they  have  reached  thie  stage 
by  a  wilful  disregard  of  ordinary  prudence.  Insane  and  idiotic 
are  considered  to  have  superior  claims  on  the  sympathy  of  the 
public.  The  state  tries  to  regulate  the  traffic  by  license.  The  U. 
S.  Court  has  decided  that  there  is  no  inherent  right  to  sell  spirits, 
because  of  the  perils  of  the  business.  License  and  attempts  to 
control  are  giving  a  right  to  destroy  one's  self  and  then  punishing 
him  for  this.  Great  inconsistencies.  No  one  has  a  right  to  destroy 
himself.  The  state  should  enforce  this.  The  present  treatment 
contrary  to  the  teachings  of  science.  Persons  who  use  spirits 
are  poisoned  and  must  be  housed  and  controlled.  The  present 
methods  dangerous.  Jails  and  station  houses,  schools  of  crime. 
The  state  should  organize  work-house  hospitals  and  control  the 
inmates.  The  incurables  to  have  indefinite  sentences.  Others 
shorter  periods  with  parol.  Almira  Reformatory.  An  object  les- 
son in  the  principles  of  treatment.  Laws  of  Conn.,  superior  to 
others.  The  practical  treatment  demonstrated  in  many  ways. 
English  hospitals  show  the  value  of  the  work.  The  Binghamton 
Asylum  outlined  the  great  principles.  Hospitals  in  their  infancy. 
The  principles  which  must  be  concentrated  and  applied  are  seen 
in  many  institutions. 

Inebriety  is  never  recognized  until  the  patient  has 
reached  conditions  that  border  on  chronicity  or  incurable 
stages.  When  such  persons  become  dependent  on  their 
friends  and  the  state,  then  it  dawns  on  the  minds  of  the 
friends  that  they  are  inebriates. 

The  State  assumes  that  where  distress  and  poverty  are 
apparently  the  direct  result  of  neglect  and  wilful  disre- 
gard of  ordinary  prudence,  there  is  no  legal  liability,  ex- 
cept in  the  extreme  stages  and  then  only  the  jail  and  alms- 
house,  and  the  most  limited  possible  means  of  protection 
should  be  given.  This  is  founded  on  the  theory  that 
inebriety  is  a  moral  disorder,  and  the  victim  is  vicious  and 
wilful  and  could  at  any  time,  by  the  exercise  of  his 
will,  have  prevented  this  condition.  Hence  this  neglect 

20  1 


262  INEBRIETY. 

should  be  punished  by  suffering  and  deprivation  of  many 
of  the  comforts  of  life. 

The  insane,  idiotic  and  epileptic  are  considered  to  have 
superior  claims  on  the  sympathy  of  the  public,  and  hence 
are  entitled  to  protection  and  kindness,  and  more  chari- 
table legislation.  The  State  assumes  that  alcohol  is  a 
necessity,  and  that  when  they  have  passed  laws  to  regulate 
its  traffic  as  a  beverage,  and  by  license  and  law  keep 
its  sale  within  legitimate  and  rational  bounds,  they  have 
done  their  whole  duty. 

The  United  States  Supreme  Court  has  decided  that 
there  is  no  inherent  right  given  to  any  citizen  of  the 
State  or  Nation  to  sell  intoxicating  liquors,  because  the 
business  is  perilous  and  dangerous  to  individuals  and  the 
community.  Hence  it  may  be  prohibited  by  regulations 
and  laws  that  any  state  may  determine. 

The  inconsistency  of  legalizing  the  business  of  selling 
spirits  and  holding  the  salesman  and  consumer  account- 
able for  the  effects  which  are  inevitable  is  very  startling. 
It  is  literally  giving  a  man  the  right  to  become  insane 
and  degenerate,  and  then  punishing  him  for  this  con- 
dition. 

Many  persons  consider  it  wisdom  to  regulate  the  sale 
of  spirits  and  use  the  money  obtained  by  the  license  for 
the  protection  of  those  who  are  injured  by  it.  This  is 
another  inconsistency  that  it  is  difficult  to  understand. 
The  economic  side  of  the  license  question  shows  beyond 
all  question  a  tremendous  loss  in  the  money  received  from 
license  funds  and  the  amount  paid  out  for  police,  hospital 
and  almshouse  expenditures  to  take  care  of  the  victims. 
It  has  been  urged  that  wherever  a  city  or  town  insists 
on  granting  the  privilege  of  selling  spirits  as  a  beverage, 
it  is  in  duty  bound  to  provide  homes  and  hospitals  for  the 
care  of  the  inebriate  and  persons  made  paupers  from 
using  spirits. 


THE   STATE    CARE  AND  TREATMENT. 


It  is  very  evident  that  the  state  must  recognize  the 
injuries  which  result  from  the  free  or  licensed  sale  of 
spirits,  and  should  use  every  possible  means  to  diminish 
or  permanently  check  the  injuries  which  follow  from  it. 

The  great  principle  is  that  no  one  should  have  a  right 
to  destroy  himself  and  become  incapable  of  doing  his 
duty  as  a  citizen,  nor  should  he  be  permitted  to  become  a 
burden  or  a  source  of  loss  and  injury  to  others  in  the 
community. 

This  principle  is  recognized  in  legislation  concerning 
public  nuisances,  sanitary  evils  and  diseases  from  every 
source  which  endanger  the  lives  and  homes  of  the  com- 
munity. Thus  pollution  of  streams  by  sewerage,  neglect 
to  remove  dangerous  infections  or  conditions  which  en- 
courage disease,  are  punished  as  offenses  and  crimes  of  the 
community. 

The  fact  is  well  recognized  that  no  one  has  a  legal 
right  to  so  act  and  conduct  himself  as  to  peril  the  sani- 
tary and  healthful  interests  of  others.  By  destroying  all 
sense  of  obligation  and  duty  to  others,  and  all  conscious- 
ness of  others'  interests,  the  inebriate  becomes  a  source 
of  danger.  His  brain  is  bewildered  and  his  reason  is  dis- 
turbed, and  he  can  not  act  or  conduct  himself  with  any 
degree  of  certainty,  hence  he  should  be  controlled,  and 
come  under  the  class  of  infectious  and  contagious  dis- 
ease victims. 

At  present  all  inebriates  are  recognized  as  sane  and 
normal,  and  allowed  to  come  and  go  with  little  or  no  re- 
striction. When  they  fall  down  in  the  street  stupid,  or 
when  they  commit  assault  or  crime,  they  are  taken  to 
hospitals  and  jails  and  the  difficulty  is  considered  only 
transient.  There  is  no  recognition  of  their  insane  acts 
and  conduct  in  their  homes,  to  their  families  and  those 
about  them. 


264?  INEBRIETY. 

Science  indicates  clearly  that  every  man,  either  as  a 
moderate  or  excessive  user  of  spirits  is  dangerous,  not 
only  to  himself,  but  to  others.  He  is  infectious  and  un- 
certain, and  is  likely  any  moment  to  become  a  burden  and 
loss  to  the  community.  He  is  not  only  insane,  but  he  is  a 
criminal  from  the  slightest  exciting  causes,  and,  more  than 
that,  he  is  almost  certain  to  transmit  his  disease  and  de- 
generation to  the  future. 

It  has  been  said  by  good  authority  that  no  man  has  a 
right  to  use  spirits  to  injure  himself  and  impair  his  con- 
sciousness of  the  surroundings  and  his  relation  to  otheis, 
and  it  is  the  duty  of  the  State  to  stop  him,  take  away 
his  liberty  and  force  him  into  conditions  of  normal, 
healthy  living. 

This  great  principle  applies  and  is  becoming  more  and 
more  thoroughly  recognized  every  year.  The  State  does 
license  the  sale  of  spirits,  but  it  is  its  obvious  duty  to 
recognize  the  inebriate  as  a  source  of  danger  and  peril 
to  its  best  interests.  The  present  methods  of  neglect, 
and  harsh  means  only  at  the  last  moment,  when  restora- 
tion is  practically  impossible,  will  disappear  in  the  near 
future. 

Every  city  and  town  should  have  hospitals  and  homes 
for  the  control  and  care  of  inebriates,  where  the  exciting 
causes  can  be  removed,  and  where  the  best  conditions  of 
hygienic  living  and  the  appliances  of  science  can  be  con- 
centrated to  bring  about  a  radical  restoration. 

Such  a  work  has  already  been  tested,  not  only  as  prac- 
tical and  rational,  but  curative.  The  inebriate  should 
be  sent  to  State  farms  and  State  colonies,  restrained  and 
made  self-supporting,  and  after  a  period  under  medical 
care,  during  which  he  has  nerve  rest,  restoration  takes 
place ;  then  he  should  be  permitted  to  go  out  on  parole 
and  return  whenever  relapses  occur. 


THE   STATE    CARE   AND   TREATMENT.  265 

If  frequent  paroles  and  relapses  show  a  degree  of  in- 
curability, the  terms  of  commitment  should  be  indefinite. 
Every  large  city  has  a  number  of  pauper  inebriates,  whose 
frequent  arrests  for  crime  and  intoxication  are  destruc- 
tive to  themselves  and  an  increasing  burden  on  the  com- 
munity. 

The  jails  and  station  houses  are  schools  for  greater  de- 
generation and  incapacity.  They  should  be  housed  in 
farm  colonies  for  an  indefinite  time,  and  provided  with 
labor  and  occupation,  and  made  self-supporting  as  far  as 
possible.  The  treatment  in  such  places  would  be  no  exper- 
iment. Already  it  has  been  demonstrated  in  many  ways. 

Some  of  the  better  class  of  jails,  private  hospitals  and 
reformatories  and  other  institutions  where  there  is  sharp 
military  restraint,  with  obligation  and  the  application  of 
persistent  restorative  measures,  show  beyond  all  question 
what  can  be  done.  Thus,  in  one  institution  receiving  the 
most  degenerate  class  of  inebriates,  where  baths  are  given 
daily,  with  good  food  and  certain  light  duties,  the  changes 
noted  are  almost  marvelous. 

Many  of  the  patients  when  discharged  give  promise  of 
permanent  restoration,  and  if  this  treatment  could  be  car- 
ried out  for  a  sufficiently  long  time,  the  results  would  be 
very  promising. 

An  ideal  institution,  which  is  thoroughly  practical  and 
will  be  positively  attained  in  the  near  future,  will  be  a 
farm  colony  in  the  country,  with  every  facility  for  farm 
and  garden  work  and  light  mechanical  labor;  small,  in- 
expensive dormatories,  built  about  a  central  administrative 
building,  would  permit  classification  and  grouping  of 
people. 

Full  legal  power  of  restraint  covering  years  should  be 
given  by  the  courts,  and  every  patient  should  have  an 
opportunity  to  go  out  on  parole  when  his  restoration 


266  INEBRIETY. 

warrants  a  resumption  of  natural,  temperate  living.  The 
patient  should  understand  that  restraint  and  control  in  an 
institution  depends  entirely  on  his  recognition  of  the  rules 
and  regulations,  and  on  his  efforts  to  take  advantage  of 
every  means  used  to  restore  his  body  and  mind. 

If  he  fails  in  any  particular,  the  restraint  will  be  in- 
creased and  his  liberty  curtailed,  and  the  duration  of  his 
confinement  lengthened.  If  he  runs  away,  he  will  be  re- 
turned and  will  be  held  in  more  strict  surveillance  than 
before.  The  institution  will  be  conducted  on  a  military 
plan,  in  which  baths,  exercise,  medicinal  measures  and  duties 
of  every  kind  will  be  carried  out  with  great  exactness. 

The  muscle  worker  will  be  required  to  engage  in  out- 
door employment  on  the  farm  or  in  the  garden  for  a  cer- 
tain length  of  time  during  the  day.  The  brain  worker 
and  the  mechanic  will  be  given  some  lighter  work  in  the 
workshop,  or  at  some  occupation  along  the  line  of  their 
previous  life-work. 

If  he  refuses  to  take  his  part  in  these  duties,  his  con- 
finement will  be  more  strict  and  his  comforts  diminished. 
If  he  perform  the  duties  cheerfully,  greater  liberty  will 
be  allowed,  more  comforts  and  some  returns  for  his  serv- 
ices, which  may  be  used  to  increase  the  luxuries  or  to 
help  others  who  are  dependent. 

Occupation  should  be  considered  a  remedial  measure  of 
as  great  value  as  medicine,  daily  baths,  electricity,  mas- 
sage, and  such  other  measures  as  seem  to  be  required  by 
the  condition  of  the  patient.  In  addition  to  this,  the 
evenings  are  to  be  occupied  with  lectures,  concerts,  musi- 
cales,  and  every  measure  to  stimulate  and  rouse  up  the 
palsied  brain. 

In  this  way,  both  days  and  evenings  would  be  a  con- 
tinuous medicinal  hygienic  culture  school  to  control  the 
disordered  impulses,  strengthen  the  nerve  energies  and 
divert  the  mind  from  the  past,  giving  it  new  impulses  and 


THE  STATE    CARE  AND   TREATMENT.  267 

thoughts  for  the  future.  The  removal  of  spirits  and  the 
active  treatment  of  disturbed  conditions  by  every  means 
known  to  science  would  be  the  first  objective  point.  Then 
a  re-education  and  materialization  of  military,  medical 
and  psychical  measures  would  restore  the  patient  to  a  nor- 
mal condition. 

Such  institutions  should  receive  the  chronic  repeaters 
and  those  found  intoxicated  on  the  streets,  grading  them 
according  to  their  conditions  and  capacity  to  live  normal, 
rational  lives.  The  military  restraint,  severe  at  first,  grow- 
ing less  as  they  show  capacity  to  bear  freedom.  When 
found  incurable,  they  should  be  placed  in  a  group  by 
themselves  and  treated  according  to  the  conditions  present. 

Another  class  less  prominent,  whose  drinking  is  more 
of  the  symptomatic  and  insane  type,  should  be  treated 
by  the  same  active  measures,  given  alternate  liberty  and 
restraint,  held  in  strict  accountability  for  the  literal 
fulfillment  of  every  duty,  and  kept  occupied  during  the 
entire  day,  when  not  resting. 

A  third  class,  whose  inebriety  is  of  a  very  recent  origin, 
should  have  special  accommodations  and  particular  oppor- 
tunities for  rest  in  suitable  surroundings.  The  first  class, 
the  incurables,  to  a  very  large  extent,  would  be  kept  in 
such  institutions  for  their  lifetime. 

They  would  become  self-supporting  in  some  measure, 
and  at  all  events  the  burdens  would  be  lifted  from  the  tax- 
payers and  their  families,  and  they  could  be  kept  in 
forced  conditions  of  healthy  living. 

The  second  class  would  be  restored  after  a  longer  or 
shorter  residence,  and,  going  out  on  parole  would  very 
likely  take  up  responsible  positions  and  live  normal  lives 
for  the  future.  The  third  class,  the  transient  and  tem- 
porary inebriates  could  be  checked  and  restored  and  sent 
back  to  healthy,  normal  living.  This  latter  class,  to  a 
very  large  extent,  could  be  cured  and  prevented  from 


268  INEBRIETY. 

becoming  chronic  inebriates  or  insane,  and  the  work  of 
a  colony  for  this  class  alone  would  be  the  highest  practical 
kind  of  preventive  medicine. 

The  practical  results  of  housing  these  three  classes 
and  taking  them  out  of  their  infectious  degenerative 
centers  would  be  a  matter  of  the  highest  economy  to  the 
public  and  to  the  community,  as  well  as  to  the  homes 
of  many  persons. 

A  colony  of  this  kind  would  do  work  equal  to  an  insane 
hospital,  not  only  by  checking  degenerative  diseases  at 
the  beginning,  but  preventing  crime  and  pauperism,  which 
is  certain  to  follow,  as  in  the  present  conditions. 

Of  course,  a  large  number  of  private  institutions  would 
be  organized  with  full  legal  power  of  control  to  treat 
persons  who  are  able  to  pay,  and  to  give  more  individual 
treatment,  and  these  are  already  on  the  ground,  only 
lacking  the  power  of  restraint  and  the  sympathy  of  the 
public.  The  pauper  and  indigent  classes  that  form  so 
large  a  burden  on  the  tax-payers,  and  the  homes  in  every 
community  would  be  lessened,  and,  by  being  grouped  and 
cared  for  in  colonies,  the  sources  of  infection  and  injury 
would  be  broken  up  and  destroyed. 

The  great  submerged  class,  that  are  going  down  and 
carrying  with  them  a  vast  tide  of  wretchedness  and 
misery,  could  be  halted  and  many  of  them  turned  back. 

Every  inebriate  hospital  and  every  quack  institution, 
and  every  reformatory  movement  by  church  or  society 
furnishes  evidence  of  the  possibility  of  cure  and  restora- 
tion, which  could  be  enlarged  and  developed  into  grand 
humanitarian  work  by  state  institutions  and  farm  colonies. 

The  Elmira  Reformator}-,  under  the  direction  of  an 
expert  manager,  demonstrated  that  juvenile  criminals 
could  be  restored  and  that  crime  could  be  checked  by  the 
use  of  scientific  means  and  measures.  This  institution 


THE   STATE    CARE  AND  TREATMENT.  269 

literally  has  revolutionized  many  of  the  great  subjects 
of  penology  and  pointed  out  new  methods  and  possibili- 
ties of  treatment. 

The  state  treatment  of  inebriates,  including  all  classes, 
can  be  equally  successful  along  similar  lines,  and  it  will 
be  no  experiment,  but  simply  a  question  of  judicious  and 
wise  management. 

Already  institutions  have  begun  in  this  direction,  and 
the  magnitude  of  the  problem  has  confused  the  managers 
in  some  way,  but  their  success  under  difficulties  has  shown 
the  possibilities  of  success  in  the  future.  One  great  diffi- 
culty is  in  trying  to  follow  theoretic  lines,  and  not  study- 
ing the  problem  as  original  and  peculiar. 

Many  years  ago  the  State  of  Connecticut  passed  laws 
giving  legal  power  to  confine  and  treat  persons  who  have 
become  inebriates,  for  a  definite  length  of  time.  This  law 
was  fifty  years  ahead  of  public  sentiment,  and  has  never 
been  utilized  except  in  a  few  private  institutions.  Of  all 
the  legal  enactments  in  the  world,  this  is  the  highest  and 
most  thorough  in  its  power  of  control. 

There  should  be  no  public  sentiment  or  opposition  or 
fear  of  abusing  personal  liberty  in  the  effort  to  establish 
farm  colonies.  The  great  fact  should  be  recognized 
that  no  one  should  be  allowed  to  destroy  himself  and  im- 
peril the  interests  of  his  friends  and  neighbors  by  using 
spirits  to  excess. 

He  should  forfeit  his  liberty  and  his  free  will,  because 
he  shows  no  ability  for  self-control,  and  hence  must  be 
cared  for  by  others.  There  is  no  subject  to-day  more 
vital  to  the  interests  of  every  community  than  that  of 
housing  the  inebriate  and  restraining  him  from  suicide 
and  injuries  to  his  friends  and  family. 

The  late  Dr.  Wright  expressed  this  in  the  following: 
"Restrain  and  control  the  inebriate,  whether  a  millionaire 


270  INEBRIETY. 

or  a  pauper,  and  you  reduce  crime,  pauperism,  criminality 
and  disease  to  a  minimum."  This  is  preventive  medicine 
and  political  economy  of  the  highest  type.  The  present 
methods  of  allowing  liberty  and  only  applying  restraint 
when  the  evils  and  injuries  are  developed,  is  reckless  ig- 
norance. In  this  way,  the  very  conditions  for  the  growth 
and  development  of  inebriety  are  promoted. 

There  is  no  science,  no  economy,  no  sense  in  this.  The 
English  Parliament,  twenty  years  ago,  recognized  the 
value  of  inebriate  hospitals,  and  appointed  an  inspector 
who  should  superintend  their  organization  and  control. 
Over  twenty  institutions  of  this  kind,  both  public  and 
private,  have  been  organized  and  are  doing  good  work. 
Under  the  care  of  an  able  superintendent  and  inspector, 
Dr.  R.  H.  Brantwaite,  very  valuable  and  interesting  con- 
tributions have  been  made  to  the  literature  on  the  subject. 

While  the  practical  working  and  value  of  such  insti- 
tutions are  established  beyond  question,  there  are  many 
difficult  problems  which  are  yet  unsettled,  and  about  which 
considerable  controversy  exists.  In  this  country,  particu- 
lar wards  are  put  aside  in  all  the  large  insane  asylums  and 
reformatories,  where  special  treatment  and  care  of  inebri- 
ates is  carried  on. 

While  this  is  unsatisfactory,  there  is  unmistakable  evi- 
dence that  work  of  this  kind  can  be  done  in  farm  colonies, 
especially  adapted  for  this  purpose.  The  first  inebriate 
asylum  at  Binghamton  distinctly  outlined  the  need  of 
such  work,  and  pointed  out  its  value  in  general,  educa- 
tional, physiological  and  psychological  training,  and  the 
possibilities  of  restoring  many  persons,  now  lost  by  the 
want  of  such  treatment. 

The  State  Asylum  at  Foxboro,  Mass.,  has  been  doing 
some  excellent  experimental  work  in  housing  and  treating 
the  chronic  inebriate.  Their  various  reports  reveal  diffi- 
culties to  be  overcome  which  a  larger  knowledge  would 


THE  STATE    CARE  AND  TREATMENT.  271 

put  aside.  The  attempt  to  divide  the  inebriates  into  cur- 
able and  incurable,  criminal  and  insane,  and  give  sep- 
arate treatment  is  beset  with  difficulties. 

Several  of  the  reports  are  marred  by  efforts  to  dis- 
tinguish between  the  normal  and  abnormal  inebriate,  and 
inebriates  whose  conduct  is  criminal  and  those  whose  con- 
duct is  not.  If  the  energy  spent  in  trying  to  differentiate 
and  mark  out  the  classes,  could  be  concentrated  in  labora- 
tory measurements  and  clinical  studies,  many  new  facts 
would  appear. 

Evidently  the  cases  are  not  thoroughly  studied  where 
the  author  spends  time  in  the  classifications  of  all  persons 
who  drink  to  excess,  and  who  may  be  practically  classified 
as  chronic,  require  hospital  treatment,  and  this  treatment 
has  but  two  objective  points,  namely,  restraint  and  train- 
ing both  mental  and  physical. 

A  well-appointed  hospital  will  regulate  this  according 
to  the  patients  and  the  conditions.  The  state  can  not 
discriminate,  except  in  a  very  general  way,  and  to  call 
one  class  curable  and  the  other  incurable,  or  one  class 
criminal  and  the  other  not  so,  and  attempt  particular 
treatment  adapted  to  each,  assumes  a  degree  of  knowl- 
edge of  the  nature  and  character  of  inebriety  not  yet  at- 
tained. 

The  temporary  treatment  of  the  inebriate  in  a  few  of 
the  older  institutions  on  a  general  line  of  classifications  is 
certainly  more  practical,  because  it  gives  opportunity  for 
special  means  and  measures  in  connection  with  other  ef- 
forts that  could  not  be  secured  in  other  institutions. 

A  state  institution  at  Knoxville,  Iowa,  is  struggling 
with  the  same  problems.  The  frequent  change  of  its 
managers  is  a  serious  obstacle  towards  any  permanent 
work.  Notwithstanding  this,  they  have  so  far  demon- 
strated the  reality  of  their  work  as  to  entitle  them  to 
the  very  warmest  indorsement  and  sympathy  of  all. 


CHAPTER  XXVI. 

TREATMENT  BY  HOT  AIR,  RADIANT  LIGHT  BATHS, 
VIBRATION  AND  ELECTRIC  CURRENTS. 


. —  These  various  means  of  treatment  becoming  more 
prominent  In  inebriety.  Opinion  of  Dr.  Shepard,  and  its  con- 
firmation. Public  baths  in  different  cities.  Literally  treating 
inebriates  in  the  acute  stages.  The  physiology  of  this.  The  baths 
in  sanitoriums  very  essential.  Effects  of  different  kinds  of  baths. 
Corn  baths  in  the  western  countries.  Their  physio'ogy  and  prac- 
tical value.  Radium  light  baths.  Their  construction.  Comparison 
with  hot  air.  Uniform  good  effects.  Action  of  light  on  the  body. 
Greatest  value  when  supplemented  with  other  measures.  Destroys 
the  desire  for  spirits,  causing  sleep.  Some  peculiarities  of  the 
light  bath  introduced  by  Dr.  Kellogg  of  Battle  Creek,  Mich. 
Vibratory  stimulation  a  valuable  agent.  Conclusions  of  the  late 
Dr.  Pilgrim.  Its  effects  on  different  organs  of  the  body.  Its 
value  increased  in  connection  with  other  measures.  Electric  cur- 
rents of  great  medicinal  power.  Static  breeze  valuable.  Alternat- 
ing currents.  Auto-condensation  currents.  Some  theories  of  their 
action.  Their  value  increased  by  other  drugs.  Some  of  these  ef- 
fects. These  are  so  uniform  as  to  give  them  a  permanent  place 
among  great  remedies.  Examples.  Psychical  effects.  Subject 
should  be  studied  with  care  and  discretion.  Their  great  value 
vrlll  then  appear. 


The  practical  therapeutic  value  of  hot  air,  steam  and 
radiant  light  baths,  together  with  massage,  vibratory  exer- 
cise by  machines,  and  the  electric  current  in  the  treatment 
of  inebriety  calls  for  extended  study  and  consideration. 
These  measures  seem  to  occupy  so  large  a  place  in  the 
treatment  of  these  toxaemias  as  to  become  essential  in  all 
therapeutic  measures  for  relief. 

Dr.  C.  H.  Shepard,  of  Brooklyn,  N.  Y.,  who  first  in- 
troduced Turkish  baths  in  America,  in  1864,  declares 
that  this  bath  is  more  of  a  specific  for  the  cure  of  in- 
ebriety than  any  single  therapeutic  means.  This  state- 
ment has  been  confirmed  in  many  ways,  and  all  authori- 
ties agree  that  in  connection  with  other  measures  it  is 

one  of  the  most  powerful  agents  now  in  use. 
272 


TEEATMENT  OF  HOT  Am,  VIBRATION,  ETC.       273 

Strikingly  confirmatory  is  the  experience  of  modern 
Turkish  baths  in  large  cities,  where  they  keep  open  all 
night  and  provide  cots  for  patrons  who  come  in  under 
the  influence  of  spirits,  and  who  after  profuse  sweating 
and  rubbing,  sleep  and  go  out  in  the  morning  restored. 

Many  of  the  baths  in  cities  give  such  treatment 
daily  to  a  large  number  of  persons,  and  they  are  literally 
inebriate  hospitals,  giving  the  first  care  and  treatment, 
although  not  generally  considered  in  this  light.  Periodic 
and  constant  drinkers  recognize  their  impaired  condition 
and  resort  to  the  baths  for  elimination  and  diversion  of 
the  spirits  from  the  blood  to  the  surface,  finding  relief 
in  the  profuse  sweating  and  rubbing,  and  the  sleep  which 
follows. 

Periodic  drinkers,  at  the  beginning  of  the  drink  storm, 
rush  to  the  bath  to  overcome  the  obsession  for  drink  and 
succeed  for  a  time.  Others,  who  fear  that  their  condition 
from  the  use  of  spirits  will  impair  their  efficiency,  go  to 
the  bath  for  the  purpose  of  sweating  it  out  and  starting 
anew. 

Thus  the  bath  has  become  a  fountain  of  healing  to  an 
increasing  number  of  persons.  The  physiological  ra- 
tionale is  very  evident.  Thus  the  high  temperature  of 
the  room  acting  on  the  surface  of  the  body  increases 
the  circulation  of  the  capillaries  and  causes  are  intense 
determination  of  the  blood  to  the  surface  of  the  body. 
This  causes  intense  perspiration,  and  is  a  literal  flushing 
of  the  body  through  the  skin,  in  which  the  toxins  and 
waste  products  of  cell  and  tissue  are  thrown  off. 

The  sudden  change  in  the  surface  circulation  overcomes 
the  vaso-motor  palsies  of  the  capillaries,  and  in  this  way 
congestion  and  pressure  on  different  organs  are  removed. 
It  is  very  much  the  same  as  flushing  the  alimentary  canal 
with  salines,  driving  off  the  waste  material  and  accumu- 
lating products. 


274  INEBRIETY. 

The  effect  is  very  marked  in  subduing  the  excitement 
and  diminishing  the  stupor  by  relief  from  irritation. 
The  heart's  activity  is  lessened,  and  the  temperature  of 
the  body  is  diminished.  The  blood  pressure  is  lowered, 
and  with  it  a  decided  tendency  to  sleep.  The  toxins  are 
eliminated,  and  thus  one's  source  of  poisoning  is  lessened. 

The  derangement  of  the  capillary  circulation  is  over- 
come, and  the  congestions  and  palsies  so  common  are  re- 
moved. It  not  unfrequently  happens  that  persons  in  the 
Turkish  baths  do  not  perspire  quickly.  There  are  sur- 
face congestions  difficult  to  overcome,  hence  large  quanti- 
ties of  water  must  be  drank,  and  the  persons  taken  out 
and  the  skin  softened  with  soap  and  massaged  under  a 
hot  shower. 

In  sanitariums,  where  the  baths  are  used  very  freely, 
the  action  of  hot  air  on  the  skin  of  inebriates  is  studied 
with  some  care.  If  perspiration  is  very  intense  from  the 
start,  after  a  massage  and  rubbing,  cold  showers  are  given, 
and  the  patient  is  wrapped  up  in  a  warm  blanket  until 
reaction  follows. 

Where  the  perspiration  is  very  tardy,  massage  of  the 
skin  and  hot  showers  precede  the  sweating.  The  effect 
of  profuse  perspiration  can  be  greatly  increased  by  flush- 
ing the  alimentary  canal  and  kidneys  with  warm  or 
mineral  waters.  After  the  bath  and  reclining  in  a  dark 
room,  and  a  short  sleep,  if  the  skin  becomes  dry  and  hot,  a 
hot  shower  is  given,  and  surface  stimulation  is  kept  up 
by  means  of  showers  and  steam  baths. 

If  the  patient  complains  of  headaches  after  the  hot  air 
bath,  a  steam  bath  may  be  given  at  intervals  of  two  or 
three  hours.  Where  the  patient  has  perspired  freely  and 
the  skin  is  in  a  hypersensitive  condition,  a  steam  bath 
may  be  given  with  better  effects  than  hot  air. 

Often  persons  delirious,  perspiring  freely,  should  be 
given  a  hot  shower,  followed  by  a  cold  douche,  then  taken 


TREATMENT  OF  HOT  AIR,  VIBRATION,  ETC.       275 

to  a  steam  bath  for  a  short  time,  then  to  a  cold  shower 
and  wrapped  up  in  blankets  in  a  dark  room. 

In  the  western  countries  corn  baths  at  one  time  were 
frequently  given  with  good  effect  and  frequency.  Large 
ears  of  corn  were  boiled  for  a  long  time,  then  placed 
around  the  patient's  body  and  covered  with  blankets.  The 
heatd  retained  by  the  ears  of  corn  produced  a  very  high 
surface  temperature,  and  this  stimulated  the  capillaries, 
bringing  about  the  same  results  as  that  from  steam. 

Diaphoretic  drugs  have  the  same  effect  with  the  addi- 
tion of  the  depression  from  the  untoward  action  of  the 
medicine.  Stimulation  of  the  skin  is  more  safely  secured 
by  external  measures,  of  which  hot  air,  steam  and  other 
baths,  are  the  best  means. 

The  radiant  light  bath,  which  has  recently  come  into 
considerable  prominence,  should  receive  some  considera- 
tion. Up  to  this  time  its  value  has  been  very  enthusi- 
astically praised,  and  by  many  it  is  considered  superior 
to  the  hot  air.  The  bath  consists  of  a  room  four  or 
five  feet  square  lined  with  tin,  or  painted,  to  give  it  a 
radiating  surface,  over  which  are  arranged  a  large  num- 
ber of  incandescent  lights.  These  lights  may  be  supple- 
mented by  reflectors  back  of  each  one,  intensifying  the 
rays. 

The  bath  may  be  in  the  form  of  a  cabinet,  in  which 
the  head  projects  and  the  body  is  surrounded  by  a  large 
number  of  incandescent  lamps.  Some  of  the  baths  are 
lined  with  mirrors,  which  intensify  the  lights. 

The  patient  sitting  in  this  bath  perspires  very  quickly. 
While  the  temperature  does  not  increase  to  more  than  130 
or  160  degrees,  the  perspiration  is  very  rapid  and  in- 
tense. The  particular  value  of  the  bath  seems  to  be  in 
its  sudden  profound  stimulation  of  the  capillaries. 

The  hot  air  bath  requires  from  fifteen  to  twenty  min- 
utes to  produce  active  perspiration.  In  the  radiant  light 


276  INEBRIETY. 

bath  the  same  effects,  only  more  powerful,  in  from  five 
to  ten  minutes.  The  temperature  remains  about  the  same. 
The  patient  is  conscious  of  a  decided  sedative,  soothing 
action.  The  sensation  of  heat  is  less  than  in  the  hot  air 
bath,  but  the  skin  is  more  intensely  reddened,  and  elimina- 
tion is  more  profound. 

In  some  instances  a  very  marked  odor  from  the  oily 
products  of  the  skin  is  apparent.  In  others,  all  odors 
seem  to  be  neutralized.  Areas  of  the  skin  that  are  hyper- 
sesthetic  and  anesthetic  are  brought  out  with  great  dis- 
tinctness. After  a  time  the  perspiration  brings  with  it  a 
sense  of  exhaustion,  and  the  patient  is  then  placed  under 
a  shower,  after  which  a  decided  tendency  to  sleep  follows. 

These  effects  are  so  marked  and  uniform  as  to  give  it  a 
greater  prominence  than  that  of  the  hot  air  bath.  Where 
the  skin  is  palsied  and  does  not  respond  quickly,  a  warm 
shower  with  soap  is  used  to  soften  the  skin  and  to  increase 
the  surface  circulation. 

Then  the  light  bath  acts  with  great  intensity.  In  the 
hot  air  bath,  there  are  often  depression  and  a  sense  of 
uneasiness  and  irritation,  but  in  the  radiant  light  bath 
these  effects  are  not  noticed. 

After  one  or  two  baths  the  skin  seems  to  become  very 
susceptible  to  the  action  of  light,  and  perspiration  starts 
almost  immediately  when  the  light  is  turned  on.  There 
can  be  no  question  that  the  action  of  light  has  a  more 
profound  physiological  action  on  the  surface  than  that 
of  hot  air. 

The  light  penetrates  to  all  the  tissues  of  the  body  and 
is  converted  into  heat  waves,  giving  renewed  activity  to  the 
cells  and  circulation  of  fluids.  It  is  practically  a  bom- 
bardment of  both  heat  and  chemical  rays,  penetrating 
through  the  surface  into  the  tissues,  destroying  the  toxins 
and  bacteria,  and  setting  up  activities  anew. 


TREATMENT  OF  HOT  AIR,  VIBRATION,  ETC.       277 

The  arc  light  is  regarded  as  the  most  powerful,  with 
its  ultra  violet  rays.  Cabinets  and  rooms  in  which  the 
arc  light  is  used  have  become  more  popular,  and  many 
very  interesting  studies  have  been  made  showing  their 
superiority  to  the  incandescent  lamp. 

In  the  treatment  of  inebriety,  the  radiant  light  bath, 
to  be  most  effectual,  must  be  supplemented  by  showers, 
massage,  and  various  other  measures,  particularly  adapted 
to  the  case.  After  the  bath  has  been  used  a  few  times, 
the  susceptibility  to  the  stimulant  action  of  light  should 
be  recognized,  and  the  duration  of  the  bath  diminished. 

If  the  hot  showers  and  massage  afterwards  are  not 
followed  by  a  sedative  action  and  sleep,  a  new  study  of 
the  conditions  should  be  made.  In  some  persons  the  sud- 
den withdrawal  of  large  amounts  of  water  from  the  sur- 
face is  in  the  nature  of  a  shock,  producing  irritation  and 
restlessness  afterwards.  In  others,  it  is  the  opposite. 

Warm  or  cold  showers  after  the  bath  may  frequently 
correct  this  condition.  This  must  be  considered  in  the 
after  treatment.  In  some  persons  this  bath  is  followed, 
after  the  rest  and  sedation,  by  an  increased  desire  for 
spirits,  but  fortunately  this  can  be  overcome  by  any  of 
the  bitter  tonics,  whose  effects  seem  to  be  much  more 
active  after  the  bath  than  before. 

Where  the  desire  for  spirits  is  diminished  accompanied 
by  an  active  impulse  to  overcome  it,  a  repetition  of  baths, 
of  short  length,  will  aid  this  impulse.  Many  very 
curious,  unexplained  facts  have  been  noted  from  the 
effects  of  this  particular  remedy.  Thus,  in  one  instance, 
a  very  nervous,  excitable  inebriate  would  fall  asleep  in 
the  bathroom  and  remain  lethargic  and  dull,  sleeping 
and  drousing  for  many  hours  after.  All  desire  for  spirits 
disappeared  as  soon  as  perspiration  began. 


278  INEBEIETY. 

In  another  instance  a  steady  drinker  could  not  sleep 
for  many  hours  without  restlessness  and  a  feeling  of 
laughter.  Later  he  would  sleep  very  profoundly  for  a 
long  time. 

In  a  third  case  it  was  necessary  to  take  a  bath  early 
in  the  morning,  as  its  stimulating  effects  lasted  all  day, 
taking  the  place  of  spirits,  and  enabling  the  person  to 
do  without  them. 

In  a  fourth  case  the  action  of  this  bath  was  followed 
by  intense  craving  for  food ;  then  sedation,  sleep  and 
restoration. 

In  the  acute  symptoms  of  inebriety  this  bath  is  uni- 
formly sedative,  and  this  effect  can  be  increased  by  warm 
showers,  carbonated  waters,  and  reclining  in  a  darkened 
room. 

Several  authors  have  spoken  about  the  particular  good 
effects  of  the  radiant  light  bath,  where  the  patients  had 
an  opportunity  to  disport  in  a  swimming  tank  and  exer- 
cise themselves.  This,  of  course,  would  happen  in  those 
who  had  used  hot  air  or  steam  baths. 

Experience  has  shown  that  where  a  person  becomes  very 
sensitive  to  the  light,  the  duration  of  the  bath  should 
be  confined  to  a  very  few  moments,  not  going  beyond  sur- 
face stimulation  of  warmth  and  moisture,  then  a  warm 
shower  and  reclining. 

Another  fact  is  of  great  significance,  namely,  that  the 
action  of  the  drugs  seem  to  be  far  more  intense  and 
active  after  the  bath.  Thus  sedatives,  cathartics  and 
tonics,  particularly  of  the  vegetable  class,  are  more  pow- 
erful, even  in  smaller  doses. 

In  alcohol  delirium  the  radiant  light  bath  has  proved 
to  be  of  almost  specific  value  in  many  instances.  Free 
catharsis  and  warm  showers  softening  the  skin,  and  pro- 
during  increased  surface  circulation,  then  a  prolonged 
radiant  light  bath.  This  is  followed  by  showers  and  re- 


TREATMENT  OF  HOT  AIR,  VIBRATION,  ETC.       279 

clining,  and  complete  subsidence  of  the  delirium  for  many 
hours. 

On  its  return  a  similar  course  was  followed  by  pro- 
longed narcotic  effect  and  rapid  recovery.  It  is  still  an 
open  question  whether  this  treatment  would  be  equally 
efficient  in  all  cases.  In  an  institution  where  such  baths 
are  in  active  service,  the  results  will  be  different  from 
those  in  a  private  home.  It  may  be  asserted  with  great 
confidence  that  any  kind  of  a  bath  by  which  high  heat 
can  be  applied  to  the  surface  of  the  body  will  always  be 
found  exceedingly  valuable. 

Dr.  J.  H.  Kellogg,  of  Battle  Creek,  Mich.,  who  first 
introduced  the  radiant  light  bath,  pointed  out  its  great 
value  as  an  eliminant  and  sedative.  He  showed  that  it 
not  only  acted  on  the  arterial  tension,  reducing  it,  but  it 
had  a  powerful  physiological  action  on  irritation,  and 
was  a  germ  destroyer. 

He  showed  that  its  effects  were  not  always  explainable, 
but  like  electricity,  it  presented  some  retarding  forces  to 
diseased  states,  and  gave  some  new  power  to  the  cell  and 
tissue.  Clinical  experience  has  brought  a  large  mass  of 
confirmatory  evidence  both  concerning  this  bath  and  that 
of  the  hot  air. 

Thus  persons  exhausted  from  overwork,  worry  and  de- 
fective nutrition  find  in  both  of  these  baths  relief  and 
sedation  greater  than  from  any  other  source.  Thus,  a 
professional  man  suffering  from  periodical  drink  storms, 
can  overcome  them  by  hot  air  baths  at  the  beginning  of 
the  period  and  in  this  way  he  has  been  able  for  many 
years  to  prevent  a  drink  excess. 

In  another  instance  an  inebriate  resorts  to  a  bath  in 
his  own  house,  taking  two  or  more  a  day,  followed  by  a 
rubbings  with  oils  and  vigorous  massage,  and  in  this  way 
he  has  been  able  to  keep  from  using  spirits. 


280  INEBRIETY. 

In  one  case  an  inordinate  thirst  which  precedes  the 
drink  storm  is  treated  with  hot  air  baths  and  salt  rubs, 
followed  by  a  static  breeze.  The  result  is  a  complete 
subsidence  of  the  drink  excess. 

A  physician  reported  a  number  of  cases  of  chronic  in- 
ebriates treated  in  a  jail  by  hot  water  douches  and  vig- 
orous rubbing  with  a  solution  of  salt.  The  results  were 
very  good.  A  number  of  cases  have  been  reported  where 
the  insomnia  following  the  inebriety  was  broken  up  by 
the  radiant  light  bath  and  salt  showers.  These,  together 
with  other  means,  were  followed  by  a  remarkable  recovery. 

Up  to  this  time  the  clinical  evidence  of  the  value  of 
this  form  of  bath  showed  that  it  is  one  of  the  new  modali- 
ties that  promise  the  very  best  results  from  farther  use. 

Another  remedial  measure  is  vibratory  stimulation  of 
the  muscles  by  delicately  adjusted  machines.  This  has 
been  found  to  be  of  great  value  in  a  large  number  of 
cases.  The  following  summary  of  its  physiological  action 
by  the  late  Dr.  Pilgrim,  outlines  in  a  very  satisfactory 
way  many  of  the  facts  which  have  been  confirmed  beyond 
all  question. 

The  action  of  vibratory  stimulation  on  the  body  is : 

1.  Increasing  the  volume  of  blood  and  limph  flow  to  a 
given  area  or  organ. 

2.  Increasing  nutrition  by  stimulating  secretion. 

3.  Increasing  the  muscular  respiratory  process  and  the 
functions,  and  the  general  metabolism  and  the  production 
of  heat. 

4.  Stimulating  the  excretory  organs  and  the  functions 
of  elimination. 

5.  Diminishing   blood    tension    and   relieving   muscular 
contractures. 

6.  Relieving  engorgement  and  congestion. 


TREATMENT  OF  HOT  AIR,  VIBRATION,  ETC.       281 

7.  Increasing  the  removal  through  the  natural  channel 
of  the  lymphatics  of  exudates  and  other  products  of  in- 
flammation. 

8.  Inhibition  and  relieving  pain. 

Evidently  these  results  and  the  need  for  stimulative 
measures  are  called  for  in  most  cases  of  inebriety.  Many 
persons  who  drink  both  moderately  and  at  intervals  suffer 
from  contractions  and  impaired  activity  of  both  the 
organs  and  glands,  and  frequently  hand  massage  and  so- 
called  osteopathic  measures  are  followed  by  the  best  results. 

Stimulation  over  the  liver  and  along  the  lines  of  the 
nerves,  for  cirrhosis  and  neuritis,  and  other  muscular 
palsies,  together  with  abdominal  muscular  stimulation, 
are  all  most  practical  and  efficient  measures  to  relieve 
the  conditions  and  assist  toward  healthy  activity. 

Several  cases  have  been  reported  where  the  premonitory 
symptoms  of  the  drink  craze  have  been  overcome  by  vi- 
bratory treatment  and  baths.  Its  use  is  indicated,  par- 
ticularly in  so-called  rheumatisms  and  sclerotic  states  fol- 
lowing the  use  of  alcohol,  and  when  used  in  conjunction 
with  electric  light  baths  and  free  showers,  the  very  best 
results  will  follow. 

Persons  who  are  overfed  and  underworked  and  who 
use  alcohol,  should  receive  vibratory  treatment.  Persons 
who  are  worn  out  from  defective  nutrition  and  continuous 
poisoning  from  spirits,  and  persons  with  enlarged  livers 
or  hearts  should  be  given  this  treatment. 

At  first  it  should  be  light  and  brief  as  to  duration,  then 
increasing  the  length  of  time,  localizing  the  vibratory 
activities  over  parts  of  the  body  that  seem  to  be  con- 
gested. A  mild  vibratory  treatment  over  the  entire  body 
stimulates  the  capillaries  and  makes  the  electric  light  bath 
much  more  active  and  in  many  ways  seems  to  give  power 
to  eliminated  drugs  by  rendering  the  circulation  more 
active. 


282  INEBRIETY. 

The  vibratory  machine,  both  before  and  after  the 
bath,  is  a  very  powerful  aid  and  a  remedial  measure, 
particularly  in  cases  of  muscular  irritation  and  insomnia. 
It  may  be  called  a  mechanical  sedative,  and  its  effects 
may  be  considered  both  physical  and  psychical. 

Its  use  in  barber  shops,  over  the  face  and  head,  shows 
that  it  is  recognized  as  an  agreeable  stimulant  as  well  as 
sedative.  In  institutions  where  its  effects  can  be  studied 
and  applied  with  more  or  less  exactness,  it  has  become 
a  necessity,  particularly  to  diminish  nerve  excitement  and 
muscular  energy,  and  to  bring  with  it  a  sense  of  relief. 

Experience  has  shown  that  its  value  consists  of  its 
scientific  rational  use,  and  that  it  is  possible  to  increase 
the  very  irritation  and  many  of  the  difficulties  which  it  is 
found  to  remove  by  a  careless  use. 

Electric  currents  from  a  static  machine  are  very  valu- 
able remedial  agents  that  are  coming  into  increasing 
prominence.  High  frequency  currents,  for  their  tonic 
effect  and  after  the  removal  of  spirits,  are  very  satis- 
factory. The  relief  and  rest  in  many  cases  is  almost 
specific.  In  others  the  effects  are  less  marked. 

The  static  breeze,  given  regularly,  varying  according 
to  the  skill  of  the  operator,  and  the  form  of  current 
which  seems  to  be  called  for,  becomes  a  very  important 
part  of  the  institutional  treatment  of  inebriety. 

In  a  general  way  it  may  be  said  that  the  electric  cur- 
rent is  either  a  stimulant  or  sedative.  Sometimes  one 
effect  is  more  pronounced  than  the  other,  and  in  all 
cases  the  sedative  effect  is  secondary,  and  is  apparent  in 
all  forms  of  treatment. 

The  alternating  current  aids  and  increases  the  assim- 
ulation  and  digestion  of  the  patient,  and  should  be  used 
in  all  after  treatment  as  a  tonic  of  exceeding  value.  Oc- 
casionally persons  intoxicated  are  restored  at  once  by  the 
action  of  the  electric  current.  In  others  stupor  and 


TEEATMENT  OF  HOT  AIR,  VIBEATION,  ETC.       283 

narcotism  is  intensified.  In  other  cases,  irritation  and  ex- 
treme restlessness  follow.  It  is  found  that  the  static 
breeze,  the  alternating  currents  and  the  auto-condensation 
currents  are  most  effectual  after  the  baths  and  hydro- 
pathic measures. 

The  electric  current  seems  to  have  a  more  intense  ac- 
tion on  the  cells  and  nerves  after  the  radiant  light  bath. 
The  fact  should  be  remembered  that  the  effects  of  elec- 
tric currents,  in  almost  any  form,  differ  very  widely  in 
neurotic  cases.  In  the  complex  conditions  which  mark 
inebriety,  these  various  effects  are  still  more  pronounced. 

It  has  been  asserted  that  there  has  been  a  distinct 
antagonism  between  the  palsy  of  alcohol  and  the  stim- 
ulating action  of  the  electric  current.  In  some  cases  this 
is  very  evident,  where  the  electric  current  was  given  for 
the  purpose  of  breaking  up  the  drink  craze.  In  some 
cases  this  effect  was  very  marked.  In  others  it  was  the 
opposite,  showing  that  the  facts  are  not  well  known  and 
the  enthusiastic  praise  and  bitter  condemnation  is  the 
best  evidence  of  this. 

It  is  the  experience  of  a  large  number  of  observers 
that  the  continued  use  of  the  alternating  current  is  a 
very  powerful  tonic  for  all  forms  of  local  and  general 
inflammatory  conditions,  following  and  associated  with 
the  use  of  alcohol. 

There  are  many  curious  clinical  facts  which  arise  from 
the  use  of  electricity  in  the  treatment  of  inebriety  that 
have  not  yet  been  formulated  into  general  conclusions, 
and  at  present  do  not  seem  to  have  been  studied  with 
any  degree  of  exactness. 

Thus  the  nausea  following  the  withdrawal  of  spirits 
is  often  completely  overcome  by  the  electric  current. 
Alcohol  is  not  tolerated  if  given  immediately  before  or 
after  the  electric  current  is  used.  The  effects  are  nausea 
and  vomiting. 


INEBRIETY. 


The  headache  and  oppression  preceding  or  following 
the  use  of  spirits  may  be  greatly  increased  or  diminished 
by  the  electric  current.  In  a  periodic  drinker  the  drink 
craze  was  preceded  by  gastralgia  and  fear  of  cancer  of 
the  stomach,  and  the  electric  current  over  this  region 
broke  up  this  impression  and  with  it  all  desire  for  spirits. 

In  another  instance  a  constant  drinker  suffered  from 
extreme  revulsion  from  the  effects  and  odor  of  spirits 
after  the  use  of  the  electric  current.  This  lasted  for 
some  months.  A  static  breeze  in  some  instances  was  used 
to  overcome  the  delirium  with  success.  In  others  it 
greatly  intensified  it.  An  enthusiastic  man  attempted 
to  treat  acute  intoxication  by  the  galvanic  current.  His 
claims  of  diminishing  the  toxic  period  and  shortening  the 
period  of  restoration  was  not  confirmed  by  other  ob- 
servers. 

There  is  undoubtedly  associated  with  the  electric  cur- 
rent a  psychical  influence,  which  charlatans  frequently 
take  advantage  of.  A  number  of  persons  are  reported 
in  which  the  influence  and  shock  of  an  electrical  current 
has  overcome  the  intoxication,  and  produced  an  intense 
revulsion  for  spirits  which  continued  for  the  rest  of  life. 

One  man  asserts  at  great  length  that  the  toxaemic 
conditions  which  follow  from  the  use  of  spirits  intensify 
the  passage  of  electric  currents,  and  that  the  man  in  this 
condition  is  more  susceptible,  has  lower  vitality,  and  more 
quickly  succumbs  to  the  disturbing  influence  of  the  cur- 
rent. 

There  are  many  facts  in  the  experience  of  reliable  au- 
thorities that  make  it  evident  that  the  tonic  and  stim- 
ulant properties  of  the  electric  current  are  a  very  valuable 
remedy  in  all  forms  of  inebriety,  particularly  when  sup- 
plemented by  other  means  and  measures. 

The  psychic  element  of  fear  and  expectancy  concern- 
ing this  agent  must  always  be  considered  and  made  use 


TREATMENT  OF  HOT  AIK,  VIBRATION,  ETC.       285 

of,  not  only  to  neutralize  the  obsessions  and  idiosyncrasies, 
but  to  increase  the  faith  and  confidence  of  the  patient. 
Undoubtedly  it  is  a  medical  agency  of  great  poten- 
tiality which  will  be  understood  in  the  future  from 
further  and  more  exact  study. 


CHAPTER  XXVII. 

MENTAL  THERAPEUTICS  AND  SUGGESTIONS  IN  THE 
TREATMENT  OF  INEBRIETY. 

Synopsis. —  Suggestion  a  very  powerful  measure  in  treatment. 
Different  theories  of  its  permanency.  Gold  cure  system  of  sug-. 
gestion.  A  blundering  effort  to  utilize  forces.  Common  illustra- 
tions of  suggestion  in  temperance  meetings.  Reasons  why  they 
are  not  permanent.  All  cases  must  be  prepared  for  suggestion  by 
removing  toxins,  and  placing  the  person  in  favorable  conditions. 
A  study  of  each  case  will  show  how  suggestion  can  be  applied 
with  advantage.  Methods  by  which  suggestion  can  be  made  ef- 
fectual. Illustrations.  Failures  of  other  measures.  Preparations 
and  use  of  means  encouraging  the  growth  of  suggestion.  Church 
clinics  and  their  methods,  failures.  How  they  could  be  made  ef- 
fectual. Summary  and  possibilities  of  this  form  of  treatment. 

Several  writers  have  affirmed  very  positively  that  sug- 
gestion and  hypnotic  influences  are  most  valuable  in  the 
cure  of  spirit  and  drug-takers ;  also  that  more  cures  fol- 
low from  this  measure  than  from  any  other. 

It  has  been  stated  elsewhere  that  the  inebriate  is  cur- 
able by  apparently  very  unusual  means,  and  that  in  all 
probability  the  cure  depends  on  some  change  in  the 
brain,  and  not  on  the  last  means  used.  The  fact  that 
recovery  dates  from  the  application  of  some  peculiar  and 
commonplace  measures  does  not  prove  that  it  is  the  direct 
result  of  these  means. 

Cures  following  the  pledge  or  conversion  are  very 
pronounced,  and  why  they  do  not  always  occur  when 
the  same  means  are  used  is  a  mystery.  Some  literature 
giving  records  of  cases  cured  by  suggestion  is  very 
startling,  but  attempts  to  repeat  these  experiences  are 
attended  Avith  so  many  failures  as  to  discourage  further 
efforts. 

One   writer    asserts    that    seventy-five    per    cent,    of    all 

inebriates    can    be    cured    by    hypnotism    or    suggestion. 

286 


MENTAL  THERAPEUTICS  AND   SUGGESTION.       287 

The  cure,  he  declares,  will  fail  in  at  least  sixty  per  cent, 
after  five  years,  and  that  not  more  than  four  per  cent 
of  this  number  will  be  permanently  restored.  This  state- 
ment is  not  based  on  very  careful  studies,  and  evidently 
is  an  opinion,  which  in  a  very  general  way  outlines  the 
facts  that  indicate  what  an  indiscriminate  application  of 
such  measures  might  possibly  bring  about. 

There  is  no  question  whatever  about  the  powerful  in- 
fluence of  the  mind  over  the  body,  and  the  possibility  of 
overcoming  diseased  impulses,  breaking  up  obsessions  and 
checking  toxins.  In  all  efforts  to  overcome  disease  the 
element  of  hope  and  confidence  on  the  part  of  the  patient 
is  a  very  essential  remedial  measure,  and  without  it  the 
results  are  not  certain  or  permanent. 

The  gold  cure  craze,  which  has  attracted  so  much  at- 
tention in  the  past,  was  literally  suggestion  and  so-called 
hypnotic  influences  made  impressive  by  the  use  of  drugs. 
When  the  patient  was  told  emphatically  that  spirits  were 
poisonous  and  injurious,  the  demonstration  by  the  use  of 
spirits  containing  nauseating  drugs  proved  it. 

Then  by  the  use  of  narcotics  in  small  quantities,  at 
short  intervals,  the  impression  of  health  and  perfect  re- 
lease from  the  drink  craze  was  built  up.  A  final  test, 
giving  spirits  with  apomorphia  and  explaining  the  phe- 
nomena afterwards  as  distinctly  that  of  poisoning,  and 
evidence  that  the  patient  could  not  use  it  in  the  future, 
so  impressed  itself  upon  the  mind  of  the  patient  that  he 
was  for  the  time  being  cured. 

Later,  when  he  recovered  to  some  degree,  an  effort  to 
confirm  the  early  impressions  proved  that  they  were  not 
real,  hence  he  relapsed.  This  great  empiric  wave  in  a 
most  blundering  stupid  fashion  brought  out  the  fact  that 
psychical  therapeutics  contain  possibilities  of  cure  be- 
yond any  conception. 


288  INEBRIETY. 

The  inebriate,  with  his  disordered  mentality  and  func- 
tional instability,  is  very  susceptible  to  mental  impres- 
sions, but  their  permanency  depends  on  a  great  variety 
of  conditions  which  must  be  controlled  with  scientific  ex- 
actness. 

The  common  illustration  of  gathering  the  drink  degen- 
erates from  the  street  and  urging  them  to  sign  the  pledge 
and  be  helped  by  prayer  and  conversion,  shows  a  degree 
of  susceptibility  and  credulity  which  should  be  utilized 
along  different  lines. 

The  reform  waves  of  pledge  signing  and  temperance 
revivals,  in  which  large  numbers  of  persons  acting  on 
suggestion  change  the  course  of  their  life  for  the  time, 
and  make  an  attempt  to  live  normally,  all  indicate  the 
value  of  psychical  therapeutics. 

Evidently,  impressions  made  at  this  time  have  little 
or  no  basis  in  mental  vigor  to  sustain  them.  It  is  also 
clear  that  there  must  be  a  certain  degree  of  normal  vigor 
on  which  to  build  up  suggestion  and  rouse  latent  im- 
pressions to  overcome  diseased  impulses.  The  inebriate, 
coming  under  medical  care,  is  always  starved  and  pois- 
oned, and  nothing  can  be  done  for  him  until  these  con- 
ditions are  in  a  measure  removed. 

We  have  outlined  the  possibility  of  this  by  hydro- 
pathic eliminative  measures,  together  with  electricity  and 
other  remedies  found  useful  in  a  general  restoration 
of  both  body  and  mind.  In  the  meantime,  a  careful  study 
will  show  the  presence  of  some  peculiar  and  special  ob- 
sessions, such  as  the  fear  of  death,  remorse  at  his  condi- 
tion, the  suffering  he  has  caused  his  family  and  parents, 
or  the  failure  of  his  ambition  for  position  or  wealth, 
and  other  states  which  can  be  called  practically  obsessions 
or  impulses  which  seem  to  dominate  and  distress  him. 

If  to  this  there  is  the  suspicious  egoism  that  he  has 
no  responsibility  in  this,  but  is  simply  the  victim  of  con- 


MENTAL  THERAPEUTICS  AND   SUGGESTION.       289 

ditions  imposed  upon  him,  which  he  could  at  any  time 
have  changed,  and  that  his  effort  to  stop  is  more  to 
gratify  others  than  himself,  a  more  pronounced  state  of 
degeneration  is  present. 

These  peculiarities  or  obsessions  indicate  the  direction 
which  suggestion  must  take,  and  the  form  of  the  mental 
therapeutics  that  is  to  be  applied.  At  an  opportune 
moment  after  the  patient  has  recovered  to  a  certain 
degree,  and  is  in  a  moderately  healthy  state  of  mind  and 
body,  he  should  be  given  a  special  treatment  and  told 
that  the  object  of  this  is  to  suggest  to  him  some  plans 
and  methods  that  will  increase  his  future  strength  and 
vigor. 

If  he  has  confidence  in  the  physician  he  will  enter  into 
this  with  great  heartiness.  He  is  then  placed  in  a  lux- 
urious chair  in  a  cheerful  room  and  encouraged  to  relax 
and  open  his  mind  to  a  confidential  talk.  Then  in  a 
monotonous  quiet  manner  the  physician  will  repeat  the 
leading  facts  of  his  life,  asking  him  to  correct  or  restate 
them,  being  careful  not  to  dwell  on  any  particular  theory 
which  he  may  have  formed. 

The  conversation  going  on  in  a  quiet  monotonous  way 
produces  a  degree  of  receptivity  in  which  the  physician 
will  suggest  the  destructive  influences  of  alcohol  and  the 
danger  of  its  future  use.  This  may  be  repeated  over 
and  over,  particularly  having  reference  to  the  patient's 
secret  fears  and  sorrows,  indicating  how  far  he  can  over- 
come these  conditions  and  make  them  impossible  in  the 
future. 

Somnolence  will  appear  after  a  time,  and  the  patient 
must  be  told  to  drowse  or  sleep,  and  during  this  quiescent 
period  the  same  idea  should  be  reiterated  over  and  over 
again  in  clear,  emphatic  language.  Then,  if  the  patient 
continues  quiet,  tell  him  to  sleep  and  that  you  will 
return  in  a  few  moments.  The  fact  of  sleeping  is  evi- 


290  INEBRIETY. 

dence  that  the  mind  is  influenced,  and  that  the  effect  de- 
sired is  accomplished  in  some  degree. 

A  day  or  two  later  give  another  similar  treatment, 
suggest  the  same  line  of  thought,  and  encourage  the  pa- 
tient to  drowse  or  sleep.  A  very  marked  influence  will 
be  noted  after  a  few  treatments  of  this  kind.  The  pre- 
vious conceptions  of  the  patient  will  apparently  change, 
and  a  species  of  re-educating  the  mind  and  conscious- 
ness will  grow  with  each  effort. 

Where  the  patient  does  not  fall  into  a  sleep  after  these 
suggestive  talks,  it  is  well  to  lay  down  the  rules  about 
certain  unimportant  matters  concerning  diet,  methods  of 
living  and  exaggerate  their  necessity,  so  that  the  mind 
may  be  diverted  from  reasoning  on  what  was  said. 
Where  the  patients  are  not  actively  receptive  to  these 
influences  it  is  well  to  find  occasion  for  a  warm  bath,  a 
static  breeze,  with  perfect  relaxation  before  the  treat- 
ment, which  should  be  at  night  so  that  the  patient  can 
retire  soon  after. 

In  some  instances  it  is  wise  to  select  a  time  of  day  in 
which  the  patient  seems  to  be  most  vigorous  and  anxious 
to  do  everything  that  will  assist  towards  his  final  cure. 
In  one  instance  a  young  man  received  a  letter  from  his 
mother  in  which  she  appealed  to  him  to  use  every  oppor- 
tunity to  make  his  recovery  permanent;  it  was  noticed 
that  this  was  the  most  favorable  time  for  hypnotic  sug- 
gestion. 

He  was  taken  to  his  room  and  in  a  very  short  time, 
after  listening  to  the  monotonous  iterations  of  the  physi- 
cian, fell  asleep ;  then  was  given  emphatic  instructions 
about  what  he  must  do.  He  was  allowed  to  sleep  until 
he  awakened  naturally.  Baths  and  soothing  measures 
were  given  in  anticipation  of  the  weekly  letter  from  his 
mother  to  make  his  condition  more  favorable  for  the 


MENTAL  THERAPEUTICS   AND   SUGGESTION.       291 

growth  of  powerful  impressions.  His  recovery  was  per- 
manent, and  his  life  has  been  very  exemplary  for  years. 

In  another  instance  an  ambitious  man  who  began  to 
drink  in  college  life,  and  whose  drinking  had  been  a  con- 
tinuous obstacle  to  his  promotion  and  success,  came  under 
treatment  in  a  condition  of  great  despair.  After  a  few 
weeks  of  vigorous  treatment  he  recovered  and  reached  a 
stage  where  he  wished  to  get  well  to  please  his  wife  and  not 
for  himself. 

He  was  given  vigorous  outdoor  exercise,  then  a  static 
breeze  and  warm  bath  and  taken  to  a  quiet  room  where 
suggestive  treatment,  particularly  enforcing  the  idea  that 
he  should  recover  to  save  his  wife  from  sorrow.  This 
was  usually  followed  by  sleep  and  great  satisfaction  after- 
wards. The  treatment  was  given  every  other  day.  Grad- 
ually the  suggestions  widened  with  the  fact  that  he  could 
not  drink  and  that  his  future  could  be  made  brighter 
than  ever  by  abstinence  from  drink.  The  results  were 
very  satisfactory,  and  his  restoration  was  pronounced. 

In  another  instance,  in  which  a  patient  believed  that 
his  drinking  was  due  to  failures  of  his  friends  to  appre- 
ciate his  strength,  various  hypnotic  treatments  had  been 
tried  with  failure.  He  had  been  a  college  athlete  and 
had  neglected  to  keep  up  his  former  exercise.  On  ad- 
mission he  was  put  in  physical  training,  walked  every 
day,  took  vigorous  baths  with  electrical  treatment.  In  a 
short  time  psychical  suggestion  was  tried  and  found  to 
be  very  effective.  He  fell  asleep  quickly  and  the  sug- 
gestions made  to  him  at  this  time  produced  a  decided 
change  in  his  delusions.  Every  other  day  he  was  given  a 
suggestive  treatment  and  was  told  that  his  delusions  con- 
cerning alcohol  must  disappear,  and  that  his  egotistic 
opinion  of  his  ability  to  control  himself  was  wrong.  His 
future  depended  entirely  on  his  use  of  means.  It  was 


292  INEBRIETY. 

noticed  that  he  was  conscious  in  a  measure  of  what  was 
said,  but  he  affirmed  that  he  had  changed  his  mind  and 
was  now  going  to  live  differently.  He  recovered. 

In  each  case  the  object  was  to  secure  perfect  relaxa- 
tion and  a  degree  of  vigor  that  would  respond  and  would 
not  in  any  way  be  interfered  with  by  any  physical 
condition.  Constipation  from  indigestion  was  treated  and 
overcome  before  suggestion  was  given,  and  every  possible 
means  used  to  secure  the  best  vigor  of  the  body,  so  that 
it  would  not  interfere  with  the  influence  of  the  mind.  In 
one  instance  a  drinking  man  had  become  practically  in- 
capacitated for  all  work.  Christian  Science  healers  made 
very  strenuous  efforts  to  help  him,  but  failed.  It  was 
noticed  that  they  paid  little  regard  to  his  present  con- 
dition, but  sought  to  overcome  his  obsession  for  drink 
by  suggestion  and  appealing  to  his  fears.  The  result 
was  skepticism,  doubt  and  despair. 

Coming  under  treatment  he  was  found  to  be  very  sus- 
ceptible to  the  Turkish  bath  and  fell  asleep  after  reclin- 
ing in  the  cooling-room.  Sometimes  this  sleep  lasted  for 
hours.  During  this  period  suggestion  was  given  to  him 
of  which  he  was  not  conscious  afterwards,  saying  that  he 
did  not  remember  of  anyone  talking  with  him. 

Later  a  special  suggestive  conversation  was  begun 
after  the  bath,  and  continued  up  to  the  time  when  he 
went  to  sleep.  After  a  few  treatments  of  this  kind  he 
announced  most  emphatically  that  he  had  lost  all  taste 
for  spirits,  and  would  not  under  any  circumstances  allow 
the  idea  to  come  into  his  mind.  Evidently  he  outgrew 
his  old  condition,  and  after  a  few  weeks'  treatment  went 
out  cured. 

Another  instance  brings  out  the  fact  in  a  more  prac- 
tical way.  A  business  man,  who  drank  every  night  to 
procure  sleep,  was  advised  to  go  to  the  Turkish  bath  in 


MENTAL  THERAPEUTICS  AND   SUGGESTION.       293 

the  early  part  of  the  evening,  then  go  to  his  home  and 
be  given  a  suggestive  treatment  while  lying  in  bed.  The 
physician  who  gave  the  treatment  followed  it  with  strych- 
nine and  atropia  tonics  and  very  minute  directions  con- 
cerning his  living  and  work  during  the  day.  The  bath 
at  night  was  to  be  followed  by  a  warm  shower.  The 
result  was  permanent  recovery. 

A  physician  who  drank  to  great  excess  went  to  the 
home  of  a  quack,  where  the  same  practical  treatment 
was  given,  principally  warm  baths  and  massage,  then 
suggestion  and  sleep.  He  recovered  and  was  most  en- 
thusiastic over  the  means  used,  although  ashamed  of 
having  been  under  the  care  of  such  a  person. 

A  distinguished  professor,  who  makes  suggestion  a 
large  element  of  treatment,  refuses  to  do  anything  for  a 
patient  who  is  using  spirits,  but  urges  that  they  become 
sober,  take  a  bath  and  attain  some  degree  of  normal 
vigor  before  he  will  apply  any  suggestions. 

In  the  various  church  clinics,  where  sleep  is  supposed 
to  favor  the  reception  and  permanency  of  the  impression, 
various  drugs  are  used  to  produce  conditions  favorable 
for  this  state.  This  seems  very  doubtful  practice,  and 
open  to  serious  objections. 

A  warm  bath,  an  electrical  breeze,  or  a  lucodescant 
light  up  and  down  the  spine  would  furnish  far  more 
favorable  conditions  for  hypnosis.  Partial  or  complete 
drug  sleep  can  not  in  the  nature  of  things  be  a  con- 
dition where  impressions  from  without  can  have  any 
permanency.  Patients  poisoned  by  toxins,  either  from 
spirits  or  formed  from  conditions  within,  are  in  unfavor- 
able conditions  for  mental  treatment. 

At  one  of  the  church  clinics  a  gormand  was  very 
anxious  to  be  directed  how  to  overcome  the  depression 
and  gloom  which  incapacitated  him.  The  operator  ad- 


294  INEBRIETY. 

vised  him  to  go  to  a  sanitorium  and  take  active  treat- 
ment, and  then  come  to  him  for  suggestion.  This  re- 
sulted in  recovery. 

In  an  institution  where  the  surroundings  can  be  con- 
trolled, and  where  the  patient's  habits  of  living  can  be 
regulated,  suggestive  treatment  can  be  made  very  prac- 
tical, but  it  is  always  wise  to  be  frank,  and  under  no 
circumstances  deceive  the  patient  as  to  the  purpose  and 
object  of  the  methods  to  be  used. 

If  the  patient  possesses  more  than  usual  intelligence, 
explain  to  him  the  use  of  mental  measures  and  how  far 
they  are  dependent  on  physical  conditions,  and  then  in- 
sist on  every  means  to  prepare  his  mind  and  body  for  the 
reception  of  impressions  that  are  given. 

If  somnolence  follows,  it  should  be  encouraged,  and 
often  the  subsidence  of  consciousness  opens  greater  fa- 
cilities for  impressing  the  subconsciousness.  Sometimes  it 
is  well  to  prepare  the  patient's  mind  by  suggestions  and 
statements  in  advance,  calling  attention  to  certain  results, 
mental  contagions,  which  follow  directly,  and  then  lead 
up  to  an  effort  to  use  this  as  distinct  medicine- 
It  is  found  that  relaxation,  both  physical  and  mental, 
are  very  largely  essential  in  awakening  the  subconscious 
and  giving  it  a  special  power  to  control  the  organism 
and  its  obsessions.  In  making  impressions  or  suggesting 
lines  of  conduct,  it  is  quite  necessary  to  bear  in  mind 
the  delusions  or  peculiar  conceptions  of  the  patient  con- 
cerning his  own  condition.  Anything  that  antagonizes 
these  former  impressions  will  excite  rather  than  soothe. 

Hence  impressions  must  be  along  lines  that  direct  the 
mind  out  into  other  and  better  conditions.  After  a  few 
treatments  a  degree  of  confidence  is  established,  then  the 
physician  can  suggest  lines  of  conduct  that  at  first  would 
not  be  favorably  received.  It  is  not  necessary  to  have 


MENTAL,  THERAPEUTICS  AND   SUGGESTION.       295 

the  patient  in  a  sleeping  state,  although  this  is  much 
more  favorable. 

Efforts  to  produce  sleep  by  colored  lights  passed  over 
the  forehead,  pressing  the  eyelids  down,  and  other  meas- 
ures are  all  practical  in  certain  instances,  and  should  be 
used  according  to  the  conditions  of  the  patient  and  his 
susceptibility. 

In  this  general  summary  the  facts  to  be  made  prom- 
inent are  these:  Many  inebriates  cannot  only  be  helped, 
but  permanently  cured,  by  psychical  therapeutics;  but 
they  must  be  used  along  rational  lines  and  in  most  fa- 
vorable conditions.  Every  physician  should  be  com- 
petent to  understand  and  use  these  psychical  laws,  and 
make  them  contribute  toward  the  restoration  of  the 
patient. 

It  is  altogether  likely  that  suggestion,  meaning  by  this 
Avord,  mental  impressions  of  every  kind,  has  a  great  deal 
to  do  in  the  growth  of  inebriety,  and  it  is  absolutely 
certain  that  the  same  forces,  properly  used,  will  be  of 
immense  help  in  the  prevention  and  cure. 


CHAPTER  XXVIII. 

HISTORY  OF  THE  EMPIRICISM  CONNECTED  WITH 
INEBRIETY. 

Synopsis. —  Empiricism  associated  with  every  great  truth. 
Early  efforts  to  cure  inebriety  by  secret  remedies.  Work  at 
Binghamton  Asylum.  Cinchona  bark  cure.  The  first  great 
specific  came  from  publication  of  The  Journal  of  Inebriety.  Its 
accidental  publicity.  Methods  of  promoting-  it.  The  interest  and 
excitement  which  followed.  An  expectancy  in  the  public  mind, 
and  failures  to  give  relief  by  other  measures  prepared  the  way 
for  this  means.  Methods  of  promotion  and  efforts  to  keep  the 
scheme  before  the  public.  Appearance  of  rivals.  One  of  the  most 
prominent  and  the  methods  used.  Their  activity  and  final  fail- 
ures. Physicians  responsible,  by  indifference  for  the  growth  of 
these  schemes.  A  second  great  rival,  promoted  as  a  stock  com- 
pany. Methods  used.  Promissory  notes  of  poor  patients  and  re- 
spectability of  board  of  managers  made  a  fortune  for  the  pro- 
moters. Efforts  to  extend  the  work  to  Europe,  and  the  failures. 
A  suit  In  the  U.  S.  Court,  in  which  the  early  history  of  these 
means  became  permanent  records.  Drugs  were  common  and  well 
known.  Contained  nothing  new.  Certain  number  of  persons 
benefited.  On  this  the  claims  of  the  institutions  were  supported. 
Drug  cures  contained  the  drugs  concealed.  Physicians  are  often 
deceived.  Hospitals  of  the  country  show  an  increasing  number 
of  persons  who  come  for  physical  treatment.  The  chief  promot- 
ers of  these  schemes  were  victims  themselves,  and  many  of  them 
are  dead  from  the  very  means  which  they  claimed  to  have  dis- 
covered as  specific  cures. 

A  study  of  the  various  means  of  treatment  used  in 
inebriety  would  be  incomplete  without  reference  to  the 
empiric  methods  and  so-called  specific  remedies  which  have 
attracted  so  much  attention  during  the  last  few  years. 

Some  details  of  these  movements  will  be  exceedingly 
interesting  as  historic  facts,  showing  that  every  advance 
in  science  brings  into  prominence  charlatans  who  seek  to 
secure  some  personal  advantage  from  these  movements. 

As  early  as  1850  there  appeared  advertisements  for 
secret  remedies  for  the  cure  of  the  drink  craze.  It  was 
evident  that  some  one  had  caught  the  idea  of  physical 
treatment  by  drugs,  and  customers  were  found. 

During  the  war  of  the  sixties  the  Binghamton  institu- 
tion appeared  and  drug  treatment  became  a  recognized 
296 


HISTORY  OF  THE  EMPIRICISM.  297 

method  of  cure.  The  inebriety  that  followed  the  disband- 
ing of  the  armies  attracted  a  good  deal  of  attention,  and 
quack  curers  came  into  greater  prominence,  but  none  of 
them  seemed  prosperous. 

In  the  early  seventies  a  cinchona  bark  cure  created  a 
great  deal  of  interest,  and  was  urged  by  physicians  as 
having  a  specific  value.  Extravagant  claims  were  made 
for  it,  but  when  subjected  to  scientific  scrutiny  and  test, 
were  not  confirmed. 

Temperance  work,  both  prayer  and  the  pledge,  were 
pressed  in  all  directions  as  giving  the  largest  hope  for 
restoration.  The  unsatisfactory  results  which  followed 
from  them,  together  with  the  desultory  efforts  of  physi- 
cians by  special  drugs  or  system  of  treatment,  prepared 
the  public  and  created  an  expectancy  that  some  time  a 
remedy  would  be  found. 

In  the  latter  part  of  the  seventies  The  Journal  of  In- 
ebriety published  a  paper  by  a  physician  in  Moscow, 
Russia,  which  claimed  very  unusual  results,  for  the  treat- 
ment of  inebriety  by  the  use  of  strychnine  and  atropia 
given  by  the  needle. 

This  attracted  the  attention  of  an  advertising  physi- 
cian, who  claimed  to  have  discovered  a  specific  cure  for 
epilepsy,  and  whose  positive  assertions  were  startling.  A 
correspondence  followed  between  the  editor  of  the  Journal 
of  Inebriety  and  the  physician,  in  which  various  sugges- 
tions were  offered,  and  possible  effects  from  certain  com- 
binations of  new  remedies  were  proposed.  Later  this 
physician  announced  the  discovery  of  a  specific  with  an 
attractive  name  for  the  cure  of  inebriety  and  epilepsy  and 
other  diseases. 

After  a  time  all  other  claims  were  dropped,  and  it  was 
announced  that  a  specific  for  inebriety  had  been  discov- 
ered. For  a  time  his  assertions  attracted  no  attention, 


298  INEBRIETY. 

and  his  claims  of  cures  by  secret  drugs  seemed  in  no  way 
different  from  other  empirics. 

Then  suddenly  the  pages  of  one  of  the  leading  news- 
papers of  the  country  were  filled  with  the  statements  of 
two  persons  who  had  been  treated  by  this  method  and 
fully  recovered.  Their  experience  and  opinions  were  de- 
tailed at  length  with  more  or  less  shrewdness. 

This  immediately  attracted  attention  and  a  number  of 
inebriates  made  a  test  of  the  treatment,  and  they,  too, 
announced  most  enthusiastically  the  reality  of  the  claims, 
and  the  marvelous  discovery  of  a  new  drug  that  would 
destroy  the  drink  craze  at  once. 

The  news  spread  far  and  near,  bringing  with  it  a 
number  of  persons  in  all  stages  of  the  drink  craze,  who 
after  four  weeks'  treatment  went  out,  proclaiming  the 
reality  of  the  cure,  and  most  enthusiastically  urging  oth- 
ers to  take  the  treatment. 

The  statement  was  published  far  and  near  that  a  new 
discovery  had  been  made,  the  evidence  of  which  was  the 
statements  of  so-called  cured  patients.  The  public  had 
been  prepared  for  this  in  many  ways  and  a  great  number 
of  persons  sought  this  new  treatment. 

The  managers,  while  greatly  surprised  at  the  sudden 
prominence  and  rush  of  patients,  realized  at  once  the 
necessity  of  taking  the  golden  tide  at  its  flood,  and 
keeping  the  commercial  side  prominent.  Large  fees  were 
charged  and  patients  were  encouraged  and  paid  to  ad- 
vertise the  work,  and  prove  its  possibilities  in  every  di- 
rection. 

Rights  were  sold  to  use  the  drug  in  certain  sections  of 
the  country,  and  open  other  institutions,  for  its  adminis- 
tration. The  original  institution  was  to  supply  the  drugs 
used  and  keep  up  the  mystery,  and  no  one  was  to  know 
what  the  drugs  used  were. 


HISTORY  OF  THE  EMPIRICISM.  299 

Appealing  to  both  the  philanthropic  and  commercial  in- 
stincts of  the  country  and  particularly  to  the  great  army 
of  inebriates  and  reformers,  they  succeeded  in  opening 
institutions  in  almost  every  state  of  the  union.  Physi- 
cians who  were  inebriates  took  the  treatment  and  entered 
with  great  eagerness  into  the  work  of  curing  others,  ac- 
cepting the  statements  of  the  promoters,  regardless  of 
ethical  principles  or  the  want  of  exact  knowledge. 

A  wave  of  the  most  extravagant  credulous  expectation, 
exploited  by  duplicity  and  cunning  swept  over  the  coun- 
try. The  claims  of  a  new  discovery  and  new  remedy,  and 
the  evidence  of  it  in  the  number  of  cured  cases,  were 
pressed  to  the  fullest  extent,  and  all  efforts  to  secure  ac- 
curate information  concerning  the  means  and  the  drugs 
used,  were  suppressed. 

Rivals  appeared  following  the  same  lines,  having  new 
and  more  perfect  remedies,  all  making  the  same  claims, 
only  differing  in  name  and  ways  of  promotion.  One  of 
these  rivals  deserves  a  special  mention  for  the  shrewdness 
and  audacity  displayed. 

Instead  of  having  a  central  home  and  requiring  pa- 
tients to  come  for  treatment,  they  went  out  into  the 
streets  and  police  courts,  and  gathered  the  most  incur- 
able cases,  giving  them  treatment  in  hired  houses,  close  by 
their  homes.  When  such  persons  had  lost  all  desire  for 
spirits  and  were  buoyed  up  with  the  faith  that  they  were 
permanently  cured,  they  became  agents  and  promoters  to 
bring  in  other  patients,  particularly  those  who  could  pay 
a  fee  for  treatment. 

These  reformed  men  were  given  a  cash  commission,  and 
visited  every  section,  wherever  patients  were  found,  plan- 
ning and  studying  how  they  could  secure  money  enough 
to  take  the  treatment,  and  posing  as  examples  of  the 
great  power  of  the  drug. 


300  INEBRIETY. 

In  a  short  time  a  large  number  of  patients  were  under 
treatment  and  the  enthusiasm  had  reached  a  high  level. 
Then  the  managers  would  organize  a  company  to  carry 
on  the  work,  hire  a  prominent  house  and  place  it  in 
charge  of  some  local  physicians,  they  furnishing  the  drugs 
instructing  the  managers  how  to  conduct  the  work,  and, 
giving  them  the  strongest  assurances  of  its  permanence. 

Sometimes  they  organized  companies  and  sold  their 
stock.  At  other  times  they  sold  out  their  rights  to  carry 
on  the  treatment.  In  this  way  many  institutions  were 
organized  and  philanthropists  and  business  men  wjpre 
greatly  interested.  At  one  time  it  was  claimed  that  there 
were  over  300  homes  in  different  parts  of  the  country, 
giving  secret  drug  treatment,  particularly  representing 
the  original  promoter  and  the  great  rival.  These  local 
institutions,  as  a  rule,  left  to  the  business  ability  and 
judgment  of  reformed  patients,  failed,  and  as  time  went 
on  relapses  increased,  and  the  number  of  patients  fell  off. 
Then  came  bankruptcy  and  disappointment. 

The  managers  adopted  disreputable  methods  to  keep 
the  work  going,  and  this  hurried  on  their  final  failure. 
Physicians  who  joined  these  various  efforts  both  for  per- 
sonal and  pecuniary  motives  lost  not  only  their  reputa- 
tion but  their  money,  and  philanthropists  and  investors 
likewise  suffered.  Tremendous  efforts  to  keep  the  work 
going  only  brought  into  promimence  the  false  claims  and 
pretensions. 

A  second  great  rival  should  be  noted  for  its  greater 
shrewdness  and  dishonesty.  Claims  were  made,  particu- 
larly among  the  wealthier  classes  of  persons,  that  a  new 
combination  of  drugs  had  been  discovered  which  were 
far  more  certain  than  anything  ever  known  before,  and 
that  its  application  had  proven  this  beyond  question. 

Some  very  shrewd  promoters  saw  an  opportunity  for 
wealth  in  this  field,  and  a  company  was  organized  with  an 


HISTORY  OF  THE  EMPIRICISM.  801 

enormous  capital,  and  a  board  of  managers,  trustees  and 
officers  of  the  highest  respectability  and  commercial  stand- 
ing. The  idea  was  pressed  that  at  last  a  new  reform 
work  had  come  which,  while  curative  and  beneficial  to  the 
poor,  who  could  be  treated  free,  it  would  be  made  profit- 
able by  charging  liberal  sums  to  those  able  to  pay. 

It  was  the  same  secret  drug  given  by  the  needle,  ac- 
companied with  the  most  extravagant  assertions  and  ex- 
pectations, uttered  in  church  and  in  public  press,  and 
accepted  as  the  last  final  discovery  in  the  world  of  sci- 
ence. 

Promoters  were  sent  to  the  poorer  sections  of  the  large 
cities  and  drinking  men  of  every  grade  were  given  four 
weeks'  treatment,  and  in  return  signed  promissory  notes. 
These  notes  were  placed  among  the  assets  of  the  company, 
and  used  to  show  the  enormous  profits  and  promote  the 
sale  of  stocks. 

Vast  sums  of  money  represented  by  these  notes  were 
accumulated,  while  the  actual  income  in  cash  was  not 
sufficient  to  pay  current  expenses.  This  the  promoters 
concealed  and  stock  was  sold  to  reformed  patients  and  the 
families  of  persons  in  which  drinking  men  existed. 

Business  men  and  speculators  interested  in  the  problem 
all  took  stock.  The  eminent  men  on  the  board  of  direct- 
ors and  the  exceeding  respectability  and  plausibility  of 
the  whole  scheme  resulted  in  the  sale  of  over  a  million 
dollars'  worth  of  stock.  A  large  part  of  this  was  cash. 
Then  suddenly  the  promoters  realized  on  the  stock,  sold 
out  and  disappeared,  and  the  board  of  directors  who  had 
given  their  names  and  influence  to  the  promotion  of  this 
scheme  withdrew  in  disgust,  leaving  only  a  few  persons 
who  had  invested  all  their  capital  in  the  company,  to  con- 
tinue the  work,  and  if  possible  get  some  returns  from  the 
wreck. 


INEBRIETY. 


This  scheme  is  still  extant  and  its  managers  are  selling 
the  prescriptions  of  the  company  to  physicians  with 
rights  to  treat  persons  in  different  sections.  As  in  all 
the  other  specifics  the  remedies  used  were  secret,  and  the 
managers  depended  largely  upon  enthusiasm,  and  asser- 
tions, and  when  the  tide  of  success  began  to  ebb,  they  de- 
serted, or  used  such  extraordinary  efforts  to  avert  the  com- 
ing storm,  that  in  reality  hastened  it. 

Another  fatal  element  was  the  management  by  re- 
formed or  cured  patients.  They  lacked  consistency  and 
persistency,  and  while  showing  some  shrewdness,  were 
reckless  and  assuming  and  depended  upon  the  element 
of  secrecy  and  appeals  to  the  credulity. 

Of  all  the  various  schemes  for  the  specific  cure  of  in- 
inbriety,  this  was  the  most  disastrous  financially  to  a 
large  number  of  persons,  and  reflected  very  seriously  on 
the  credulity  of  a  number  of  respectable  men. 

The  original  specific  curers,  in  their  desperation  to  hold 
their  own  interests,  went  into  court  to  force  a  rival  to 
pay  damages  for  infringing  on  their  name  and  methods. 
Two  long  suits  followed  in  the  U.  S.  Courts  in  which  the 
various  remedies,  means  of  treatment  and  methods  of  in- 
fluencing the  public  were  brought  out  in  great  detail. 

The  result  was,  the  case  was  dismissed  on  the  ground 
that  both  plaintiff  and  defendant  were  unclean  in  the 
eyes  of  the  law  and  using  disreputable  means  to  pro- 
mote their  own  interests.  The  records  of  this  suit  are  a 
most  interesting  psychological  study,  both  of  the  men 
who  promoted  them,  and  the  remedies  used,  together  with 
the  various  means  and  methods  to  keep  up  the  interests  of 
the  public  and  attract  the  attention  of  patients. 

The  specific  drugs  which  they  claimed  to  have  discov- 
ered have  been  repeatedly  analyzed  and  found  to  be 
combinations  of  well  known  remedies,  containing  nothing 
new  or  unknown  to  the  profession,  although  the  promoters 


HISTORY  OF  THE  EMPIRICISM.  808 

still  insist  that  they  have  discovered  new  drugs  and  new 
effects.  Many  of  these  cures  are  still  advertised  and 
thoughtless  physicians,  without  knowledge  of  the  sub- 
ject, have  been  more  or  less  responsible  by  sending 
patients  to  them,  or  permitting  them  to  go,  and  thus 
keeping  the  work  alive.  Many  relapsed  patients  still  go 
to  these  places.  The  public,  without  any  particular  in- 
formation, give  a  sort  of  a  quasi-recognition  of  their 
existence. 

Out  of  these  empiric  efforts  there  has  grown  a  wide 
spread  sentiment  that  inebriety  can  be  cured  by  physical 
means  and  methods.  This  is  based  not  only  on  the  result 
of  the  empiric  means  used,  but  other  evidence  which  is 
accumulating  in  every  direction. 

All  the  large  hospitals  and  various  sanatoriums  and 
homes  for  nervous  people  receive  such  patients,  and  pro- 
vide special  wards  for  them,  and  relapsed  cases  go  from 
place  to  place  with  confidence  and  promise  of  restoration. 
Many  of  the  opium  cures  which  have  come  up  within 
the  last  twenty  years  are  merely  different  forms  of  opium 
concealed  in  other  drugs  and  offered  as  specifics.  They 
have  never  retained  any  prominence,  although  from  the 
advertisements,  they  are  still  patronized,  but  there  is  no 
general  endorsement  of  them.  Repeated  exposures  of 
their  disreputable  methods  have  very  little  influence,  ex- 
cept to  advertise  them. 

Lists  of  opium  takers  are  compiled  and  sold  from  one 
institution  to  the  other,  and  the  army  of  repeaters  going 
from  one  place  to  another  are  very  numerous. 

Out  of  all  these  quack  measures  and  means  a  few  in- 
stitutions have  emerged  claiming  to  do  legitimate  work  on 
ethical  principles,  using  rational  means  and  measures. 
They  are,  as  a  rule,  managed  by  a  different  class  of  men 
from  the  early  promoters. 


304  INEBRIETY. 

On  the  continent,  the  empiric  alcohol  and  drug  curers 
were  forced  by  law  to  register  the  exact  drugs  used. 
This  was  to  be  open  and  free  for  the  observation  of  any 
one.  As  a  result  they  were  not  prosperous,  although  a 
number  of  drugs  are  advertised,  and  some  sent  to  this 
country,  with  very  pretentious  claims. 

The  quacks  in  England  had  no  restrictions,  but  the 
conservatism  of  the  country  made  it  impossible  to  get  any 
prominent  recognition.  There  are  at  least  a  dozen  very 
shrewdly  named  combinations  of  drugs,  advertised  to  cure 
the  drink  craze  at  home,  and  without  any  publicity. 
They  have  repeatedly  been  analyzed  and  exposed,  but 
this  does  not  seem  to  make  any  impression  on  their  ap- 
pearance in  the  public  press.  The  empiric  treatment  of 
inebriety  is  rapidly  passing  away,  and  the  public  have 
lost  confidence  in  anything  that  depends  on  secrecy  and 
pretention. 

Yet  the  continued  finding  of  new  drugs  and  continued 
pretensions  of  new  discoveries  show  that  the  element  of 
credulity  has  not  died  out.  It  is  a  curious  fact  that 
many  of  the  great  promoters  of  these  different  schemes, 
particularly  those  who  posed  so  prominently  before  tLe 
public,  died  from  the  disease  for  which  they  claimed  to 
have  found  a  cure. 

Others  disappeared  and  their  loud  pretentious  claims 
are  matters  of  history.  The  future  historian  of  the  great 
superstitions  and  empiric  waves  of  the  century  will  in- 
clude the  alcohol  specifics,  and  the  credulity  and  excite- 
ment which  followed  from  it,  as  among  the  great  events  of 
the  closing  years  of  the  century. 


CHAPTER  XXIX. 

CRIMINAL  INEBRIATES  AND  MEDICO-LEGAL 
SUPERSTITIONS. 

Synopsis. —  Confusions  of  medical  testimony  concerning  the 
responsibility  of  inebriates.  Constant  conflicts  between  doctors 
and  lawyers.  A  summary  of  six  different  cases  in  which  these 
questions  were  settled  on  false  theories  and  assumptions.  These 
examples  represent  a  very  large  number  of  persons  who  are  con- 
tinually before  the  courts  for  crime  committed  while  drinking. 
The  assumptions  of  the  court  and  the  strain  to  make  the  physi- 
cians recognize  these  assumptions.  The  evident  defects  of  the 
brain  from  a  spasmodic  or  continuous  use  of  spirits.  Crime  the 
natural  result  of  the  continuous  or  paroxysmal  use  of  spirits, 
resembling  epileptoid  paroxysms.  No  Inebriate  can  be  regarded 
as  sane.  No  possibility  of  forming  lines  between  sanity  and  in- 
sanity. A  matter  of  facts,  not  theories.  Physicians  should  have 
but  one  purpose  in  the  court  room,  of  presenting  facts  no  matter 
what  the  conclusions  may  be.  He  should  act  judicially  and  never 
be  forced  into  explanation,  where  only  theories  can  be  used  as  a 
guide.  Some  of  the  delusions  in  a  court  room  when  questions  of 
responsibility  are  raised.  General  considerations  and  summary 
of  what  is  required. 

The  medico-legal  relations  of  inebriates  accused  of 
crime  are  most  confusing.  Theories  both  ancient  and  mod- 
ern are  reiterated  with  dogmatic  confidence  and  both 
judge  and  juries  are  hopelessly  involved  and  have  most 
confused  ideas  of  inebriety  and  its  relations  to  responsibil- 
ity and  crime. 

As  an  illustration  of  the  conflicts  between  facts  and 
theories,  records  of  six  different  homicides  are  selected, 
where  the  questions  of  responsibility  and  the  conditions 
present  were  the  subjects  of  some  controversy.  These 
cases  are  in  no  way  different  from  others  which  are  con- 
stantly coming  under  legal  recognition. 

In  each  of  these  examples  the  prisoner  was  convicted 
and  suffered  the  extreme  penalty  of  the  law.  In  each 
there  was  a  pronounced  history  of  using  spirits  to  excess 

before  and  also  at  the  time  the  crime  is  committed.     The 

305 


306  INEBRIETY. 

defense  in  each  case  was  insanity  from  inebriety  and  al- 
coholism, with  incapacity  to  judge  of  the  nature  and 
consequence  of  the  acts. 

The  prosecution  urged  that  the  use  of  alcohol  in  no 
Avay  lessened  the  responsibility  of  the  prisoner,  or  dimin- 
ished the  average  mental  capacity  to  realize  the  nature 
and  consequence  of  the  act.  They  also  urged  that  the 
use  of  alcohol  must  be  considered  as  evidence  of  some 
motive  and  not  of  impaired  sanity. 

The  judges  clearly  sustained  the  verdicts  of  the  jury 
and  congratulated  them  on  the  equity  and  justice  of  their 
findings.  One  judge,  in  his  sentence,  predicted  that  when 
inebriates  realized  the  majesty  of  the  law  which  would 
permit  no  excuse,  but  hold  them  accountable,  such  crime 
would  be  lessened. 

Other  judges  were  harsh  or  pathetic  in  their  sentences, 
all  believing  that  the  prisoner  was  accountable,  and  could 
have  controlled  himself  if  he  wished.  The  medical  testi- 
mony to  the  prosecution  was  a  strange  mixture  of  theories 
and  delusions  concerning  inebriety  and  the  acts  of  per- 
sons under  its  influence. 

Nearly  all  the  witnesses  believed  that  a  man,  unless  in- 
toxicated was  accountable,  could  reason  wfsely  and  had 
the  power  of  control,  and  the  legal  conceptions  of  insan- 
ity and  inebriety  were  regarded  as  exact  proofs  which 
science  could  and  dare  not  deny,  but  must  confirm. 

The  prosecution  made  very  emphatic  the  theory  that 
intoxication  under  no  circumstances  could  be  an  excuse 
for,  or  urged  in  defense  of,  crime,  and  the  medical  wit- 
nesses of  the  prosecution  seemed  to  bring  their  facts  down 
to  fit  these  conclusions.  A  grouping  of  some  of  the  main 
facts  of  each  case  will  bring  out  more  clearly  the  errors 
and  mistakes. 

In  the  first  case,  as  in  all  others,  the  physicians  were 
made  to  acknowledge  that  they  knew  the  teaching  of  the 


CRIMINAL  INEBRIATES.  307 

law,  that  intoxication  was  no  excuse  for  crime.  Starting 
from  this  point  the  great  effort  seemed  to  be  to  keep 
down  all  testimony  that  conflicted  with  this  dictum. 

The  facts  in  the  prisoner's  history  were  that  he  came 
from  a  degenerate  family  in  which  insanity,  inebriety, 
pauperism  and  idiocy  had  appeared  in  many  members. 
He  had  been  an  inebriate  tramp,  had  suffered  from  de- 
lirium tremens,  sun  stroke  and  typhoid  fever. 

In  occupation  he  was  a  gambler,  a  hotel  manager  and 
a  hack  driver,  and  lived  very  irregularly.  He  drank 
daily,  but  seldom  to  intoxication.  One  day  after  an  al- 
coholic excess  he  threatened  to  kill  a  man.  The  next  day 
while  intoxicated  he  renewed  that  threat,  and  the  third 
day  he  sought  and  killed  the  man. 

While  drinking  to  excess  continuously,  he  was  seldom 
stupid.  At  the  trial  two  expert  physicians  swore  that  he 
had  full  power  of  realizing  the  nature  and  consequence 
of  his  acts.  As  he  Avas  driving  a  hack  at  the  time,  and 
acted  rationally,  he  could  not  have  been  insane  or  uncon- 
scious of  what  he  was  doing.  They  called  alcohol  a 
stimulant  and  doubted  its  paralyzing  action,  except  in 
excessive  doses.  In  defense  the  prisoner  was  called  an 
alcoholic  dement. 

In  the  second  case  the  prisoner  killed  his  brother.  He 
claimed  to  have  no  recollection  of  the  act,  or  what  had 
happened  for  a  day  or  so  before  and  only  recovered  his 
memory  after  being  in  jail  for  forty-eight  hours.  He 
was  a  periodic  inebriate  and  had  been  drinking  every 
night  for  two  weeks. 

During  this  time  he  begged  money  and  when  refused 
declared  he  would  have  it  if  he  had  to  kill  some  one.  The 
next  day  his  brother  was  found  murdered,  and  he  was  in 
possession  of  money.  He  had  served  in  the  army  in  1864 
and  had  drunk  from  that  time,  at  intervals,  living  a  very 


308  INEBRIETY. 

irregular  life.  His  father  was  an  inebriate  and  his 
mother  died  in  an  insane  asylum. 

On  the  trial,  several  physicians  swore  that  he  was  of 
sound  mind  and  fully  capable  of  knowing  what  he  did, 
even  when  under  the  influence  of  spirits.  On  the  other 
side,  the  medical  testimony  showed  that  he  was  insane  and 
delusional,  and  could  not  have  been  conscious  of  the  con- 
sequence of  his  act. 

In  the  third  case,  a  man  of  more  than  usual  ability, 
after  an  injury  from  a  railway  accident,  became  a  low 
inebriate,  worked  as  a  barkeeper,  pawnbroker,  drank 
continuously,  and  was  never  delirious  or  stupid. 

Finally  he  killed  a  low  woman  companion  and  ran 
away.  Minute  evidence  of  his  unchanged  appearance, 
both  before  and  after  the  act,  was  presented,  and  the  same 
clash  of  medical  testimony  appeared.  One  declared  him 
sane  and  the  other  insane. 

Case  four  was  of  a  low  drinking  Italian  laborer  who 
drank  every  night  to  a  stupor,  and  worked  during  the 
day  time  with  apparent  consciousness  of  surroundings. 
He  killed  the  barkeeper  who  refused  to  sell  him  more 
spirits.  The  same  testimony  was  offered  by  medical  wit- 
nesses for  the  prosecution  and  defense. 

The  fifth  case  was  of  an  inebriate  who  murdered  his 
wife.  He  had  been  a  periodic  inebriate  for  many  years 
and  lately  had  had  delusions  of  his  wife's  infidelity,  that 
were  never  manifest,  except  when  the  man  was  drinking. 
In  the  free  intervals  there  was  apparent  sanity,  but  while 
drinking  he  was  suspicious,  violent  and  intensely  irritable. 
The  same  conflicting  testimony  declared  him  sane  and 
insane. 

The  sixth  case  was  a  farmer,  who  drank  cider  brandy 
continuously  for  years,  and  in  a  rage  at  his  brother-in- 
law,  who  was  trying  to  help  him,  shot  him.  The  history 
showed  a  marked  decline  of  both  mind  and  body  for  a 


CRIMINAL  INEBRIATES.  309 

long  time  before  the  homicide,  and  on  the  trial  he  was 
apathetic  and  stupid. 

In  three  of  these  cases  the  medical  evidence  offered 
showed  the  irresponsibility  of  the  criminals  who  were  more 
or  less  exhausted,  and  yet  the  impression  was  created  that 
it  was  simply  paid  testimony  and  did  not  represent  the 
facts. 

One  medical  witness  declared  that  alcohol  was  always  a 
stimulant  and  could  not  be  called  poisonous  except  in 
extremely  large  doses.  The  old  theory  of  the  right  and 
wrong  test,  and  the  capacity  to  control,  with  free  will  as 
to  the  nature  of  the  acts,  was  pressed  to  the  fullest  ex- 
tent. 

The  assumption  of  capacity  and  responsibility  was 
based  on  the  fact  that  the  act  was  not  performed  in  a 
stupid  wildly  intoxicated  condition,  hence  the  person  knew 
what  he  was  about. 

The  idea  was  prominent  in  many  of  the  cases  that  a 
defense  of  insanity  must  depend  on  the  delirium,  idiocy 
or  evident  dementia  of  the  person,  and  unless  these  symp- 
toms are  very  pronounced,  there  could  be  no  claim  of  ir- 
responsibility. 

The  idea  was  pressed,  although  sharply  denied  by  some 
of  the  medical  men,  that  a  number  of  thoroughly  insane 
men  exhibit  a  degree  of  mental  acuteness  and  vigor,  fully 
equal  to  that  of  most  sane  persons.  This  idea  was 
treated  as  fiction. 

In  each  one  of  these  cases  the  evidence  of  irresponsibil- 
ity was  founded  on  a  distinct  chain  of  facts  that  could 
have  no  other  interpretation.  Thus  in  the  first  case  a 
marked  heredity  and  distinct  psychosis,  intensified  by  a 
sun-stroke  and  the  continuous  poisoning  of  alcohol  was 
unmistakable. 

In  the  second  case  a  neurotic  inheritance  coupled  with 
explosive  drink  paroxysms  and  consequent  failures  to 


310  INEBRIETY. 

reason  accurately  concerning  the  nature  and  conduct  of 
his  acts  was  undoubtedly  present. 

In  case  three  a  distinct  injury  to  the  brain  was  followed 
by  a  pronounced  change  of  symptoms  and  character,  and 
the  sequel  showed  a  diseased  brain. 

The  other  three  cases  had  equally  pronounced  symp- 
toms of  disease,  only  they  were  not  studied.  In  all  these 
cases  there  was  an  automatic  activity  that  was  mistaken 
for  sanity.  The  principle  fact  of  excessive  use  of  alcohol 
both  as  a  cause  and  symptom  of  previous  conditions,  es- 
caped the  attention  and  was  not  considered. 

It  is  a  fair  assumption  that  these  six  cases  represent  a 
very  large  class  of  persons  that  are  continually  coming 
before  the  courts,  and  are  judged  by  theories  and  legal" 
opinions  that  have  no  support  in  modern  facts.  To 
assume  the  sanity  of  any  person  who  uses  spirits  to  excess 
at  intervals  or  continuously  is  not  supported  by  the  facts. 

The  continued  depression  and  temporary  exaltation  of 
the  heart  and  functional  activities  must  of  necessity  im- 
pair not  only  the  power  of  control,  but  the  capacity  to 
reason  from  the  impaired  impression  of  the  senses. 

To  assume  that  toxaemias  from  alcohol  are  a  mere  tem- 
porary derangement  of  the  same  class  as  indigestion,  ex- 
haustion from  muscular  work,  is  untrue  and  dangerously 
misleading. 

The  result  of  accurate  experiments  shows  that  very 
small  quantities  of  spirits  have  a  measurable  paralyzing 
action  on  both  the  senses  and  functional  activities  of  the 
body.  It  is  obviously  impossible  to  continuously  depress 
all  the  vital  functions  of  the  mental  and  physical  organ- 
ism and  retain  health. 

Beyond  this  there  is  a  wide  realm  of  favorable  soils 
and  conditions  which  intensify  the  depressing  action  of 
alcohol,  and  produce  states  of  exhaustion  which  call  for 
relief  for' which  alcohol  is  the  most  grateful  remedy. 


CRIMINAL  INEBRIATES.  311 

It  has  been  shown  elsewhere  that  in  at  least  one-third 
of  all  inebriates,  the  use  of  alcohol  is  a  symptom  of  some 
brain  defect,  either  congenital  or  acquired,  or  some  latent 
tendency  to  exhaustion,  which  is  manifest  in  the  craze  for 
spirits. 

Not  only  is  it  a  symptom,  but  an  acute  exciting  cause 
of  pronounced  degenerations  and  defects.  It  is  very  evi- 
dent that  a  man  with  defective  heredity,  or  a  distinct 
neurosis,  who  begins  to  drink,  has  started  on  a  career  of 
pronounced  degeneration. 

In  addition  to  this,  the  well  known  fact,  that  in  all 
instances  every  small  dose  of  spirits  has  a  distinct  meas- 
urable effect  en  both  the  senses  and  reasoning,  is  almost 
conclusive  of  the  unsoundness  of  persons  in  this  condi- 
tion. 

The  continuous  drinker  is,  of  course,  much  more  im- 
paired than  one  who  uses  spirits  at  intervals  with  periods 
of  rest  between  them.  The  intoxicated  man  is  clearly  in- 
sane. While  this  may  apparently  be  transient  there  can 
be  no  question  of  its  profound  impairment  of  the  power 
of  sane  thought  and  act. 

Rational  acts  and  conduct  must  be  automatic,  particu- 
larly along  accustomed  lines.  Outside  of  that  the  ca- 
pacity of  the  brain  to  appreciate  and  judge  of  the  condi- 
tions is  weakened. 

The  clinical  facts  do  not  sustain  the  assumption  that 
the  effects  from  continuous  or  transient  use  of  alcohol  are 
temporary  and  easily  overcome.  The  question  of  how  far 
the  person  was  unable  to  understand  the  nature  and  con- 
sciousness of  his  acts,  or  if  he  did  understand  them  had 
the  power  of  control,  must  be  decided  according  to  each 
individual  case.  The  recognition  that  alcohol  paralyzes 
the  higher  functions  of  the  brain,  particularly  conscious- 
ness and  the  recognition  of  right  and  wrong  would  seem 


812  INEBRIETY. 

to  make  it  one  of  the  most  positive  agents  known  to  pro- 
duce conditions  of  insanity. 

The  depression  of  the  senses  is  also  another  very  sig- 
nificant fact,  suggesting  delusions  and  hallucinations  of 
all  descriptions.  Amnesia  is  another  most  significant  con- 
dition. Thus  physiologically  the  evidence  would  seem  to 
be  very  pronounced  that  all  inebriates  are  impaired  and 
mentally  unable  to  sanely  comprehend  the  conditions  of 
surroundings  and  their  relation  to  them. 

Crime  would  be  a  most  natural  result,  and  this  is  found 
to  be  the  case.  The  more  prominent  the  inebriety  and 
the  longer  its  duration,  the  greater  the  incompetence  of 
the  brain  to  act  rationally  and  soundly.  The  effort  to 
find  a  dividing  line  where  sanity  and  insanity  joins,  or 
where  persons  in  this  condition  realize  their  acts,  and  have 
the  power  of  control,  is  an  absolute  impossibility. 

All  crime  committed  by  inebriates  and  persons  under 
the  influence  of  spirits  is  the  result  of  brain  defects,  brain 
unsoundness  and  weakness.  Delusions,  illusions  and  hal- 
lucinations with  morbid  impulses  gathering  and  breaking 
like  storms  in  the  sky  are  the  common  conditions,  inevi- 
table from  this  soil. 

The  fact  that  all  persons  who  drink  do  not  commit 
crime  is  largely  a  matter  of  accident  with  very  few  ex- 
ceptions. Such  persons  have  most  favorable  conditions 
and  soils  for  the  growth  of  criminal  acts.  The  inebriate 
who  suddenly  is  exposed  to  temptation,  falls  with  little  or 
no  resisting  power. 

Thus  a  moderate  drinker,  whose  conduct  as  a  book- 
keeper in  a  large  bank  was  beyond  all  question,  when 
promoted  to  a  cashier  and  exposed  to  temptation,  acted 
most  insanely  and  became  a  defaulter.  The  conditions 
were  the  same  in  both,  only  different  kinds  of  temptation. 

The  adjuster  of  a  large  insurance  company  became  in- 
volved in  criminal  acts  and  bitter  controvcrsv.  He  was  a 


CRIMINAL  INEBRIATES.  813 

moderate  drinker  and  an  inebriate,  hence  his  brain  was 
impaired.  A  total  abstainer,  taking  his  place,  adjusted 
the  claims  without  the  slightest  friction. 

In  court  no  claim  of  insanity  would  have  been  allowed, 
for  the  acts  of  this  adjuster,  and  yet  he  was  obviously 
unsound.  The  man  who,  under  the  influence  of  spirits, 
talks  of  homicidal  acts,  only  needs  favorable  circum- 
stances to  execute  them.  The  same  man  who  acts  in  a 
most  unusual  unreasonable  manner  against  his  own  inter- 
ests is  on  the  verge  of  doing  some  of  the  most  insane 
things  without  consciousness  of  them. 

In  the  disputed  cases  that  come  before  the  court  a  care- 
ful study  should  be  made  of  the  explosive  epileptoid  char- 
acter of  his  conduct.  There  is  always  the  possibility  of 
masked  epilepsy  or  insane  conduct  as  explosions  of  nerve 
force. 

A  careful  study  both  before  and  after  the  act  that  is 
questioned  will  indicate  how  far  the  brain  is  impaired  and 
unconscious  at  the  time.  The  subsidence  of  the  acute 
symptoms  and  the  change  of  the  person's  manner  and 
conduct  are  always  to  be  regarded  with  critical  interest 
and  not  to  be  considered  as  evidence  of  perfect  sanity. 

The  intervals  between  the  epileptoid  paroxysms  may  be 
automatic  sanity  and  reasoning.  The  same  is  true  of  the 
inebriate.  His  mental  impairment  is  very  evident  from 
the  sudden  change  of  conditions  and  strain  of  unusual 
circumstances  and  surroundings,  and  exhaustive  study  of 
the  criminal  in  the  prison  is  very  often  misleading. 

The  fact  that  no  evidence  of  unsoundness  is  present 
gives  no  indication  of  mental  soundness  under  other  cir- 
cumstances and  conditions.  It  is  a  legal  superstition  to 
overlook  the  conditions  which  lead  up  to  the  crime,  and 
to  regard  the  thought  and  conduct  of  the  criminal,  long 
after  the  execution  of  the  act  as  evidence  of  his  previous 
state. 


314  INEBRIETY. 

The  physician  who  is  called  to  give  evidence  in  the 
case  of  a  criminal  inebriate,  has  only  two  facts  to  de- 
termine. One,  that  of  the  condition  of  the  prisoner  pre- 
vious to  the  crime,  particularly  his  hereditary  history  and 
his  use  of  alcohol;  the  other,  the  character  and  nature  of 
the  crime. 

Opinions  and  theories  as  to  the  present  condition  of  the 
person  are  insignificant  and  should  be  regarded  as  of 
minor  importance.  In  the  cases  mentioned  the  physicians 
called  to  give  testimony  in  the  defense  of  the  prisoner 
were  asked  to  explain  the  wide  difference  between  his  pres- 
ent condition  and  the  alleged  insanity  at  the  commission  of 
the  crime. 

They  failed  to  give  sufficient  prominence  to  the  drink 
history  and  to  show  the  impossibility  of  mental  soundness 
after  the  use  of  alcohol.  The  delusion  that  insanity  could 
come  on  like  a  fit  of  sickness  without  any  special  predis- 
posing exciting  causes  and  pass  off  leaving  the  patient 
sane  and  responsible  again  was  made  the  stumbling-block 
in  many  instances. 

The  real  fact  that  insanity  and  inebriety  were  diseases 
with  beginnings,  development  and  termination,  following 
distinct  ranges  of  causes,  and  uniform  lines  of  growth 
was  ignored.  In  place  of  this  inebriety  was  regarded 
as  a  transient  moral  weakness,  always  under  control,  and 
insanity  only  apparent  by  pronounced  symptoms  of 
mania  and  delusions. 

It  is  farcical  for  a  medical  man  on  a  witness  stand  to 
be  drawn  into  an  explanation  of  metaphysical  theories  of 
inebriety  and  questions  of  responsibility.  He  should  al- 
ways refuse  to  give  an  opinion  on  presumptuous  cases 
which  involve  a  mixture  of  half  facts  based  on  moral  and 
legal  theories  outside  of  all  clear  tangible  evidence. 

He  should  refuse  to  give  any  explanation  of  motives, 
or  determine  the  capacity  of  control  of  any  person  under 


CRIMINAL  INEBRIATES.  815 

the  influence  of  alcohol,  or  on  the  commission  of  certain 
distinct  acts.  He  should  testify  plainly  of  the  incom- 
petency  of  all  persons  poisoned  by  spirits  to  act  sanely 
and  wisely  under  given  conditions. 

He  should  never  be  drawn  into  details,  but  be  allowed 
to  give  probable  facts  and  the  general  conclusions  from 
such  facts.  The  central  questions  should  be:  Was  the 
prisoner  an  inebriate  in  the  general  sense  of  that  word? 
What  was  the  history  of  his  drinking  before  and  at  the 
time  of  the  commission  of  the  act?  What  was  the  nature 
of  the  act  and  the  conditions  which  lead  up  to  its  perpetra- 
tion? What  conclusions  or  general  facts  did  they  sug- 
gest ? 

If  these  facts  sustain  the  natural  history  of  continuous 
alcoholic  degeneration  and  defective  reasoning  with  sense 
perversions  they  must  be  regarded  as  supporting  the 
probability  of  disease  of  the  brain  and  the  unaccount- 
ability  of  the  act. 

There  can  be  no  possible  boundary  lines  where  sanity 
and  insanity  join,  or  where  responsibility  and  irrespons- 
ibility unite.  If  the  history  shows  that  toxoemic  poisoning 
and  neurosis  and  psychosis  are  associated,  the  physician 
must  reason  on  general  principles  and  not  on  possible 
exceptions.  The  prisoner  cannot  be  normal  and  sane  with 
a  history  of  continuous  unsoundness  and  perversion  long 
before  the  act  was  committed.  Every  year  the  facts  are 
becoming  more  and  more  prominent  that  crime  by  persons 
who  use  spirits  to  excess  are  insanities  in  the  broadest 
sense  of  that  word,  and  that  all  legal  treatment  founded 
on  theories  before  modern  science  had  established  the  phys- 
ical basis  for  crime  is  unjust. 

Physicians  and  expert  witnesses  make  a  serious  mistake 
in  attempting  to  harmonize  facts  and  theories  and  give 
exact  interpretation  of  motives  and  conduct  according  to 
historic  conceptions  of  insanity  and  inebriety.  It  is  a 


316  INEBRIETY. 

legal  fiction  and  delusion  to  suppose  that  crimes  commit- 
ted while  under  the  influence  of  alcohol  are  voluntary  acts 
of  a  conscious  brain. 

It  is  a  delusion  to  interpret  acts  that  indicate  premed- 
itation, particularly  in  inebriates,  as  evidence  of  the 
sanity  and  consciousness  of  their  nature.  It  is  a  delusion 
to  consider  inebriety  a  mere  transient  condition  in  which 
the  victim  chooses  to  poison  himself  for  years  and  at  all 
times  has  the  power  of  restraint,  and  is  always  sane  and 
accountable. 

It  is  a  delusion  to  consider  alcohol  as  a  stimulant  when 
all  scientific  study  contradicts  this.  It  is  a  delusion  to 
suppose  that  the  man  who  is  not  wildly  stupid  or  intox- 
icated from  the  use  of  spirits  is  able  to  control  himself 
and  reason  accurately  concerning  his  surroundings. 

It  is  a  sad  delusion  of  the  law  when  it  insists  on  fixing 
boundary  lines  of  responsibility  and  irresponsibility,  and 
brings  medical  men  into  this  penumbraeregion  of  sanity 
and  insanity  to  draw  lines  and  indicate  where  human 
justice  should  punish  and  where  it  should  remit  crime. 

The  medical  man  on  the  witness  stand  should  be  the 
same  as  at  the  bed-side.  The  questions  are  those  of  facts, 
not  of  the  theories,  but  of  present  conditions  and  their 
meaning. 

The  frequent  criticisms  of  lawyers  of  the  unreliability 
of  expert  testimony  grows  out  of  the  foolish  efforts  of 
physicians  to  harmonize  facts  and  theories  and  point  out 
in  detail  conclusions  which  could  only  be  determined  from 
a  very  long  and  exhaustive  study. 

The  physician  in  the  court  room  should  be  a  scientific 
teacher  with  no  other  thought  than  the  facts  and  their 
sequences,  irrespective  of  all  antagonism  to  theories. 


CHAPTER  XXX. 

FORMS  OF  IRRESPONSIBILITY,  ALCOHOLIC  AMNESIA, 
CLAIMS  OF  PRISONERS,  ETC. 

Synopsis. —  Statements  of  no  memory  in  inebriates  likely  to  be 
true.  Amnesia  more  or  less  common  in  inebriates.  Often  the 
lapses  of  memory  can  be  verified.  Very  commonly  seen  in  alco- 
holism, inebriety  and  epilepsy.  Often  traced  to  epilepsy,  traumata 
and  shocks.  Persons  suffering  from  this  condition  act  and  talk 
sanely,  seldom  giving  evidence  of  no  memory.  They  act  auto- 
matically. The  condition  is  one  of  central  brain  paralysis.  If 
the  patient  has  been  insane  in  the  past,  and  is  degenerate  and 
suffering  from  neurotic  disease  this  condition  may  be  expected. 
Some  examples  given.  One  of  kleptomania.  Third  of  homicide. 
The  fourth  of  forging.  These  examples  were  verified  by  ample 
testimony.  Examples  of  cases  where  the  claim  of  no  memory 
could  not  be  verified.  Several  classes  of  inebriates  evidently 
suffer  from  this  form  of  palsy.  One  class  marked  by  degenera- 
tion, heredity,  psychosis.  A  second  class  where  the  crime  is  ex- 
plosive and  maniacal.  A  third  class  where  the  crime  is  sudden  and 
precipitous.  This  resembles  masked  epilepsy.  Some  practical 
questions  to  be  considered.  The  claims  of  no  recollection  should 
be  the  subject  of  careful  study  to  verify  or  disprove.  The  im- 
portance of  the  subject.  The  danger  of  such  persons.  A  sum- 
mary of  the  facts  to  be  considered  in  a  study  of  these  cases. 


The  frequent  statements  of  prisoners  in  court,  that 
they  do  not  have  any  recollection  of  the  acts  or  crime 
they  are  accused  of,  is  found  from  exact  study  to  be  both 
a  pathological  and  physiological  fact.  While  the  evidence 
may  be  uncertain  in  many  instances,  it  is  unmistakable 
in  others,  that  crime  is  committed  without  a  conscious 
knowledge,  or  memory  of  the  acts  and  conduct  at  the 
time. 

It  is  a  well  recognized  fact  that  in  certain  states  of  the 
brain  that  are  not  understood,  memory  is  palsied,  and  the 
mind  fails  to  register  the  events  for  certain  distinct  peri- 
ods. Like  the  somnambulist,  a  person  may  seem  to  realize 
his  surroundings  and  show  a  certain  consciousness  in  his 
acts  and  later  be  unable  to  recall  anything  which  has  hap- 
pened. 

317 


318  INEBRIETY. 

These  lapses  of  memory  occur  in  many  disordered  states 
of  the  body  and  brain,  but  are  usually  of  short  duration, 
and  seldom  attract  much  attention.  Often  persons  are 
unable  to  recall  what  they  did  at  such  a  time,  but  long 
afterwards,  the  events  are  recalled  very  distinctly. 

These  memory  blanks  or  amnesias  have  been  noted  more 
commonly  in  cases  of  epilepsy,  inebriety  and  alcoholism. 
They  evidently  occur  in  many  other  conditions,  and  are 
sometimes  traceable  to  poisons,  traumata  and  shocks.  In 
inebriety,  they  are  always  associated  with  the  moderate 
or  excessive  use  of  spirits. 

Such  persons  go  about,  acting  and  talking  sanely, 
giving  little  or  no  evidence  of  brain  disturbance,  other 
than  that  of  mild  stupor  or  excessive  activity,  and  ap- 
parently conscious  of  events  and  their  surroundings. 
Later  they  awake  and  deny  all  recollection  of  acts  or 
events  for  a  certain  period  in  the  past. 

This  period  to  them  dates  from  a  certain  point  and 
ends  hours  or  days  after,  the  interval  being  a  total  blank 
like  that  of  unconscious  sleep.  In  the  meantime  automatic 
brain  activities  go  on  as  usual.  The  paralyzing  action 
of  alcohol  evidently  centers  on  some  brain  areas,  and  later 
passes  away.  In  the  meantime  registration  of  events  is 
suppressed. 

The  claims  of  a  criminal  to  have  no  memory  or  recollec- 
tion of  acts  that  he  is  accused  of,  should  suggest  the  ex- 
cessive use  of  spirits  or  some  form  of  epilepsy  or  spasm 
of  the  blood  vessels  of  the  brain,  which  may  be  inferred 
from  a  variety  of  symptoms. 

States  of  masked  epilepsy  are  to  be  sought  for  in  a 
study  of  the  causes.  If  a  history  of  moderate  or  excessive 
use  of  spirits  can  be  made  out,  it  is  a  reasonable  inference 
that  the  statement  of  the  person  may  have  some  basis  in 
facts. 


FORMS  OF  IRRESPONSIBILITY,  ETC.  319 

If  the  person  has  been  insane,  in  the  past,  and  has  re- 
covered; or  has  been  injured  by  sun  or  heat  stroke;  or 
has  been  eccentric  in  conduct  and  thought,  and  is  a  neu- 
rotic; amnesias  are  very  likely  to  occur. 

In  determining  the  accuracy  of  the  statement  of  the 
person  that  he  has  no  recollection  of  his  acts,  a  very  care- 
ful history  of  his  mental  and  physical  condition  is  essen- 
tial, and  in  most  cases  corroborative  or  disproving  facts 
can  be  brought  out. 

A  clinical  history  of  some  cases  will  give  a  very  clear 
view  of  these  amnesic  states.  The  first  example  was  that 
of  a  man  who  was  repeatedly  arrested  for  horse  theft. 
He  always  claimed  to  be  unconscious  and  have  no  memory 
of  the  act. 

The  defense  was  regarded  with  ridicule  by  court  and 
jury,  and  more  severe  sentences  were  imposed  after  each 
act,  until  finally  he  died  in  prison.  The  evidence  brought 
out  in  different  trials  in  defense  was  this: 

His  father  was  feeble-minded  and  died  of  consumption 
in  early  life.  His  mother  was  insane  and  died  in  an 
asylum.  His  early  life  was  one  of  hardships  with  lim- 
ited education  and  great  irregularities  of  living.  At  six- 
teen he  entered  the  army,  suffered  from  exposure,  sun- 
stroke and  fevers  and  began  to  use  spirits. 

At  twenty  he  was  employed  as  a  hack  driver  and  ten 
years  later  became  owner  of  a  livery  stable.  He  drank 
steadily,  yet  attended  to  business,  acting  sanely,  and  ap- 
parently conscious  of  all  his  acts,  but  often  complained 
that  he  could  not  recollect  what  he  had  done. 

When  about  thirty-four  years  of  age,  his  drinking  in- 
creased, and  in  a  state  of  semi-stupor  he  would  bring  back 
strange  horses  to  his  stables  and  claim  he  had  bought 
them.  The  next  day  he  would  claim  no  recollection,  and 
show  considerable  anxietv  to  find  the  owner  of  the  horses. 


INEBRIETY. 


Later  the  owner  would  appear  and  the  horses  would  be 
given  up,  with  various  explanations. 

It  appeared  that  after  a  certain  time  of  excessive 
drinking  the  sight  of  a  good  horse  hitched  up  at  the  road 
side,  or  apparently  without  an  owner,  created  an  intense 
desire  to  possess  and  drive  it.  If  driving  his  own  horse, 
he  would  stop  and  leave  it  in  some  secure  place,  then  go 
and  take  the  new  horse,  and  after  a  short  drive  take  it 
to  his  livery  stable,  then  go  and  get  his  own  horse,  and 
explain  to  the  stable  men  that  he  had  bought  the  new 
one. 

He  would  fall  asleep  and  awaken  without  any  recollec- 
tion of  where  he  had  been  and  what  he  had  done.  On 
several  occasions  he  displayed  cunning  and  shrewd  rea- 
soning in  not  taking  the  horses  when  the  owners  or  drivers 
were  in  sight.  When  once  in  possession  of  the  horse  he 
displayed  equal  cunning  in  going  about  the  back  streets, 
and  concealing  his  identity,  and  bringing  the  horse  to  the 
stable  in  the  most  secretive  way. 

Should  the  owner  appear  and  demand  his  property  he 
would  give  it  up  in  a  confused,  abstracted  way.  No 
scolding  or  severe  language  made  any  impression  on  his 
mind.  Often  if  the  horse  seemed  weary  and  worn,  he 
would  take  it  to  the  nearest  stable  with  strict  orders  that 
it  should  have  special  care. 

On  one  occasion  he  joined  in  a  search  for  a  stolen  horse, 
and  found  it  in  a  stable  where  he  had  placed  it  many  days 
before.  Of  this  he  had  no  recollection.  In  another  in- 
stance he  sold  a  horse  which  he  had  taken,  but  would  not 
take  any  money,  making  a  condition  that  the  buyer 
should  return  the  horse  if  he  did  not  like  it. 

His  horse  stealing  was  all  of  this  general  character. 
There  was  no  particular  motive,  and  sometimes  no  effort 
at  concealment,  and  on  recovering  from  his  alcoholic 
excess,  he  showed  great  interest  and  anxiety  in  having  the 


FORMS   or   IRRESPONSIBILITY,   ETC.  321 

property  restored,  and  expressed  regrets  and  payed  very 
freely  for  all  losses. 

His  assertion  of  amnesia  and  unconsciousness  of  his 
acts  was  sustained  by  a  great  variety  of  evidence,  but  his 
automatic  mental  activity  and  cunning  was  made  the 
standard  of  his  mental  condition.  This  was  a  marked 
case  of  amnesia  and  kleptomania  which  was  not  recog- 
nized by  the  court. 

The  next  example  was  that  of  B ,  who  was  ex- 
ecuted for  the  murder  of  his  wife.  He  asserted  positively 
that  he  had  no  recollection  or  consciousness  of  the  act,  or 
of  any  event  before  or  after.  The  evidence  indicated  that 
he  was  a  periodic  inebriate  of  ten  years'  duration,  dating 
from  a  sun-stroke.  His  drink  periods  would  last  from  one 
to  two  weeks,  during  which  time  he  drank  large  quanti- 
ties of  whiskey  daily,  was  intensely  excitable,  active  and 
seldom  stupid.  He  seemed  sane  and  conscious  of  his  acts 
and  surroundings,  but  was  intensely  suspicious  and  exact- 
ing and  irritable  with  all  his  associates.  He  would  then 
go  to  sleep,  awaken  in  a  few  hours,  and  have  no  recollec- 
tion of  what  had  happened  during  this  drink  period. 

When  sober  he  was  kind,  generous  and  confiding  and 
seldom  angry  or  irritable.  While  drinking  his  intellect 
seemed  more  acute  and  sensitive.  His  business  was  con- 
ducted with  skill  and  great  attention  to  detail.  The  only 
peculiarity  was,  he  would  make  no  promises  and  sign  no 
papers,  and  refused  to  settle  difficult  questions  of  busi- 
ness. 

When  sober,  he  was  prompt  and  exact  in  carrying  out 
all  his  promises.  His  associates  were  very  careful  to  put 
down  every  item  of  business  and  obligation  of  the  firm  in 
writing,  for  the  reason  that  when  he  became  sober,  he 
would  deny  and  doubt  the  transactions. 

On  several  occasions  destructive  manias  appeared,  in 
which  he  showed  violence  without  cause,  and  later  had  no 


INEBRIETY. 


memory  of  it  and  was  very  penitent  and  sought  in  every 
way  to  repair  the  injury. 

Finally  he  struck  his  wife  with  a  chair  and  killed  her, 
and  awoke  next  day  in  jail.  He  disclaimed  all  knowledge 
of  the  crime,  was  anxious  to  die,  plead  guilty  and  wel- 
comed his  execution.  There  could  be  no  question  about 
the  amnesia  and  the  loss  of  memory,  accompanied  by 
maniacal  and  homicidal  tendencies,  and  yet  the  defense  of 
irresponsibility  made  no  impression  in  the  court. 

The  third  example  was  that  of  a  man  of  wealth  and 
character,  who  forged  a  large  note,  and  went  to  a  distant 
city.  He  was  arrested,  tried  and  sentenced  to  state's 
prison.  The  defense  was  irresponsibility,  amnesia  and 
unconsciousness  of  the  crime,  by  reason  of  excessive  use 
of  spirits.  Evidence  showed  that  he  had  drunk  to  excess 
at  and  before  the  crime,  and  yet  his  apparent  rational 
conduct  and  cunning  in  concealing  his  identity  were  re- 
garded as  sanity. 

Both  his  parents  were  neurotics.  He  began  to  drink 
in  early  years  and  was  a  moderate  drinker  for  a  long 
time.  Then  he  drank  to  excess  at  short  intervals.  He 
complained  of  loss  of  memory  after  drinking  heavily,  and 
doubted  transactions  that  he  had  made  while  in  this  state. 
Frequently  he  would  make  foolish  purchases,  discharge 
valuable  workmen  and  later  take  them  back  without  being 
able  to  explain  the  reason  for  his  acts.  His  mental  con- 
dition at  this  time  was  reserved  and  one  of  acute  con- 
sciousness of  his  acts,  and  later  he  claimed  that  he  had  no 
recollection  of  what  he  did.  He  forged  many  notes  for 
small  amounts,  and  after  denying  that  he  had  done  so, 
settled  with  great  difficulty. 

Finally  he  forged  a  large  amount,  drew  the  money 
and  invested  it  at  once.  When  arrested  he  made  a  most 
childish  defense  in  foolish  conflicting  statements.  This 
was  another  case  of  alcoholic  amnesia  in  which  the  his- 


FORMS  OF  IRRESPONSIBILITY,   ETC.  323 

tory  of  the  prisoner's  conduct,  and  his  assertions  of  no 
memory  were  verified  by  the  facts  and  circumstances  of 
the  crime. 

The  following  case  illustrates  the  difficulty  of  confirm- 
ing the  prisoner's  statement  of  amnesia  and  unconscious- 
ness of  acts.  An  inebriate  killed  a  man  in  a  fight.  He 
was  sentenced  for  life.  His  defense  was,  no  memory  or 
recollection  of  the  act. 

When  not  drinking  he  was  a  very  ordinary  frank  man, 
acted  with  caution  and  reason,  and  showed  good  judg- 
ment as  to  the  consequence  of  his  conduct.  He  was  a 
periodic  drinker  and  drank  in  so-called  moderation  for 
two  or  three  months,  then  would  stop. 

During  this  drink  period  he  showed  great  sensitiveness 
about  his  condition  and  tried  to  conceal  it  and  appear 
sober.  If  anything  happened  he  would  display  great 
cunning  in  covering  it  up.  When  delirious  and  under 
the  influence  of  spirits  he  would  grow  sober  at  once,  from 
fear  of  exposure  and  publicity.  He  seemed  to  have  the 
power  of  control  to  act  sanely  on  occasion  and  with 
motives. 

The  crime  was  an  accident,  and  at  once  he  showed 
great  judgment  in  concealment  and  efforts  to  make  it  ap- 
pear that  he  was  not  guilty.  When  arrested  he  claimed 
unconsciousness  of  the  act,  but  his  previous  conduct  did 
not  reveal  any  facts  that  would  indicate  this  condition. 

On  the  contrary,  he  seemed  to  be  acutely  conscious,  and 
yet  it  is  possible  that  he  was  unconscious.  The  exalted 
delirium  may  have  been  followed  by  amnesia,  but  at  the 
time  he  acted  with  the  most  highly  sensitive  conscious- 
ness of  what  he  was  doing. 

In  another  case  a  man  shot  his  partner  in  business  while 
both  were  intoxicated.  He  disp^ed  unusual  sanity  and 
cunning  in  concealing  the  crime  and  having  the  body  sent 
away.  He  made  the  same  claim  in  defense.  In  a  study 


INEBHIETY. 


of  his  previous  history  there  were  no  incidents  that  in- 
dicated any  times  of  marked  loss  of  memory.  In  his 
business  relations,  even  while  intoxicated,  he  was  always 
able  to  judge  of  his  conduct  and  appeared  as  if  more  than 
usually  conscious  of  his  acts  and  consequences.  In  all 
probability  this  defense  was  fictitious  and  without  support. 

Of  these  cases  where  a  defense  of  no  memory  of  the  act 
is  claimed,  there  are  certain  groups  of  common  physical 
conditions  of  degeneration  that  can  be  outlined  with  more 
or  less  distinctness.  Probably  the  largest  number  of  in- 
ebriates who  claim  loss  of  memory  in  defense  of  their 
acts  are  chronic  psychosis  cases  in  which  alcohol  is  both 
a  symptom  and  a  very  active  cause. 

The  history  shows  excessive  use  of  spirits  for  a  long 
period,  either  continuously  or  in  paroxysms.  This,  with 
bad  training  in  early  life,  bad  surroundings  and  bad 
nutrition  would,  of  necessity,  result  in  great  mental  im- 
pairment and  liability  to  many  and  diverse  brain  defects. 

If  to  this  there  is  added  a  history  of  bad  heredity,  the 
probability  is  much  greater  that  their  claims  are  correct. 
Such  persons  have  always  impaired  consciousness  and  de- 
fective realization  of  their  acts  and  conduct.  They  usually 
are  governed  by  the  lowest  and  most  transient  impulses, 
and  act  automatically  in  the  ordinary  relations  of  life. 

Crimes  of  all  kinds  are  generally  accidents,  depending 
on  the  surroundings  and  conditions,  and  not  on  premedita- 
tion or  plan.  They  are  incapable  of  reasoning  sanely, 
or  of  realizing  the  results  of  their  conduct,  and  the  crime 
shows  this,  particularly  in  the  marked  indifference  after- 
wards. 

Crimes  of  such  persons  are  usually  along  lines  of  pre- 
vious conduct  and  thought,  and  seldom  in  a  sphere  of 
mental  or  physical  activity  unusual  or  outside  of  their 
every-day  surroundings. 


FORMS   OF   IRRESPONSIBILITY,   ETC. 

The  claim  of  amnesia  is  very  likely  to  be  real,  even  al- 
though it  cannot  be  sustained  by  collateral  evidence. 
Mania  is  very  rarely  present.  Concealed  delusions  and 
morbid  impulses  of  a  melancholic  type  are  common.  The 
mind  resembles  the  body  in  exhaustion  and  feebleness,  and 
acts  along  lines  of  least  resistance. 

A  second  group  of  persons  accused  of  crime  who  claim 
to  have  no  recollection  of  the  acts,  are  those  in  whom  the 
crime  was  unusual,  unforeseen  and  extraordinary.  Such 
persons  are  paroxysmal  inebriates,  periodic  drinkers,  dip- 
somaniacs, who  suddenly  use  spirits  with  or  without  any 
cause,  and  drink  to  great  excess,  become  prostrated,  and 
only  stop  when  acute  inflammatory  conditions  begin. 
During  this  drink  obsession  their  conduct  and  reasoning 
is  essentially  maniacal,  and  while  they  appear  to  be  con- 
scious and  to  reason  from  cause  to  effect,  it  is  a  matter  of 
some  doubt  how  far  they  are  conscious  or  are  governed 
by  accurate  recollections  and  full  consciousness  of  their 
condition. 

They  are  evidently  unsound,  unreasonable  and  inca- 
pable of  control.  The  claim  of  amnesia  should  always  be 
recognized  as  a  possibility,  and  receive  the  most  careful 
consideration.  No  sane  reasoning  or  conduct  should  be 
considered  as  evidence  per  se  of  a  clear  registration  of 
events,  and  no  conduct  afterwards  should  be  regarded  as 
conclusive  evidence  of  memory,  unless  confirmed  by  other 
facts. 

A  third  class  of  criminal  inebriates  frequently  claim  as 
a  defense  amnesia  and  want  of  memory.  Many  of  the 
pronounced  symptoms  of  insanity  seen  in  the  second  class 
are  absent.  Not  infrequently  there  is  little  or  no  his- 
tory of  alcoholic  psychosis,  imbecility,  stupor  and  gen- 
eral degeneration. 

They  are  the  so-called  moderate  drinkers,  persons  who 
use  beer  and  spirits  in  fixed  quantities  daily  for  long 


326  INEBRIETY. 

periods  of  time,  never  seem  intoxicated,  never  greatly  in- 
capacitated for  the  ordinary  duties  of  life,  and  not  in- 
frequently occupying  positions  of  responsibility,  and  ap- 
parently doing  the  work  of  sane  and  responsible  men. 

Suddenly  such  persons  commit  crime  with  suspicious 
coolness  and  indifference  as  to  the  consequences.  The 
crime  is  open,  seldom  concealed,  and  the  conduct  and  ap- 
pearance after  gives  little  evidence  of  the  realization  of 
the  acts.  In  the  defense  the  person  will  claim  no  recol- 
lection, and  the  evidence  in  support  of  this  is  the  unrea- 
sonable act  and  the  senseless  conduct  after. 

A  study  of  such  cases  opens  a  very  interesting  field  of 
dementia,  concealed  delirium  and  delusions,  and  claim  of 
no  memory  is  very  likely  to  be  true.  Other  cases  are 
noted  where  the  crime  is  committed,  following  great  men- 
tal irritation  and  depression,  or  a  drink  explosion; 

riome  condition  of  spasm  resembling  masked  epilepsy 
precedes  the  act,  and  there  is  a  strong  probability  that 
memory,  consciousness  and  reasoning  were  all  paralyzed 
for  the  time,  and  that  the  conduct  was  automatic,  im- 
pulsive and  maniacal. 

In  some  studies  of  these  cases  there  is  a  history  of  un- 
usual suspicion,  delusions  and  degrees  of  irritation  and 
perturbation,  followed  by  a  drink  storm  and  unaccount- 
able acts  in  which  crime  is  committed,  then  follows  a  sub- 
sidence of  the  acute  symptoms  and  leaving  amnesia  and  a 
blank  concerning  the  past. 

This  was  called  a  trance  state  years  ago,  and  perhaps 
this  term  describes  a  sudden  suspension  of  the  registration 
of  events  as  clearly  as  local  palsies  can  be  marked  out  in 
the  extremities.  That  this  blank  is  not  always  permanent 
is  true  in  many  instances. 

Many  persons  drinking  to  stupor  are  fully  unconscious 
of  their  condition  at  the  time,  but  later  they  can  recall  the 
events  with  considerable  accuracy.  Crime  committed  dur- 
ing this  period  is  always  more  or  less  automatic,  follow- 


FORMS  OF   IRRESPONSIBILITY,   ETC.  827 

ing  some  previous  lines  of  conduct,  and  showing  a  marked 
failure  to  appreciate  the  relation  of  the  surroundings. 

Some  governing  center  has  suspended,  and  various  im- 
pulses may  merge  into  acts  any  moment,  regardless  of 
conditions  and  restraint.  Evidently  these  blanks  of  mem- 
ory are  more  or  less  common  in  persons  who  use  spirits, 
and  they  increase  with  the  mental  feebleness  and  de- 
generations of  the  person. 

The  statement  is  often  made  that  the  person  could 
recall  after  an  interval,  the  occurrences  while  under  the 
influence  of  alcohol.  Later  his  memory  became  more  and 
more  indistinct,  until  finally  he  was  unable  to  remember  in 
any  way  what  had  happened  during  this  period. 

The  practical  question  to  be  determined  at  a  given  case 
is  the  general  mental  condition  of  the  person  who  sets  up 
a  claim  of  amnesia.  The  evidence  must  be  based  largely 
on  collateral  facts  and  inferences  supported  by  circum- 
stances. The  court  should  decide  whether  this  defense  is 
of  sufficient  magnitude  to  require  an  expert  examination 
and  study  of  the  mental  conditions  of  the  prisoner. 

The  results  of  such  expert  study  may  show  a  large  pre- 
ponderance of  evidence  sustaining  this  claim.  Then  the 
measure  of  responsibility  will  be  modified,  and  their  legal 
treatment  will  vary.  The  great  central  principle  should 
never  be  minimized,  that  the  inebriate  of  all  these  varied 
classes,  who  claims  to  have  been  unconscious  should  be 
recognized  as  insane,  and  incapable  of  realizing  or  con- 
trolling the  facts,  and  should  be  kept  under  legal  and 
medical  surveillance  for  a  long  time. 

Such  men  are  dangerous  and,  like  victims  of  contagious 
disease,  must  be  housed  and  treated.  Alcoholic  amnesia 
is  a  veritable  condition  that  should  be  recognized,  and  its 
claim  should  not  be  regarded  as  a  mere  subterfuge  to 
avoid  punishment,  but  should  receive  the  same  attention 
and  study  that  any  claim  of  insanity  calls  for  in  self- 
dofen^o. 


328  INEBRIETY. 

This  outlying  view  indicates  a  practical  field  of  medico- 
legal  research  that  is  largely  unknown,  but  evidently  is 
more  or  less  prominent.  These  cases  appeal  to  us,  and 
the  highest  dictates  of  humanity  and  science  call  for  an 
accurate  study  and  comprehension  of  their  presence  and 
character. 

The  following  summary  may  assist  in  grouping  the 
facts  to  be  considered  in  these  cases.  First,  amnesia  is  a 
distinct  central  brain  palsy,  that  exists  beyond  all  ques- 
tion or  doubt. 

Second,  it  is  a  particular  state  in  which  memory  and 
consciousness  of  acts  and  words  are  depressed,  suspended 
and  cut  off,  and  the  patient  goes  about  automatically  with 
little  or  no  evidence  of  this  change.  The  duration  of  this 
palsy  may  last  from  a  few  moments  to  several  days,  and 
the  person  appear  conscious  and  natural  along  the  line 
of  ordinary  life. 

Third,  during  this  amnesiac  period  crime  against  per- 
son or  property  may  be  committed  without  plan  or  mo- 
tive. When  accurately  studied,  the  details  and  methods 
of  execution  will  lack  evidence  of  premeditation  and  con- 
sciousness of  its  nature  and  results.  After  the  commission 
of  the  act  a  certain  indifference  and  want  of  recognition 
of  what  he  has  done  will  also  mark  his  conduct. 

Fourth,  when  the  question  comes  up  in  the  court,  and 
the  accused  denies  any  recollection  of  the  event  in  ques- 
tion the  facts  to  be  settled  are,  whether  statement  is 
a  simulation  or  a  reality,  and  what  evidence  may  be 
grouped  to  sustain  or  disprove  his  defense. 

Fifth,  the  central  question  should  be  his  drug  psycho- 
sis and  the  neurotic  psychosis,  tendencies  and  degenera- 
tions which  have  come  down.  If  this  is  clearly  made  out 
there  is  a  strong  probability  of  this  particular  defect,  and 
when  it  is  fully  established,  the  legal  irresponsibility  of 
the  person  should  be  the  same  as  that  of  an  insane  man. 


CHAPTER  XXXI. 

MEDICO-LEGAL  QUESTIONS  OF  INEBRIETY. 

Synopsis. — New  field  of  study.  Suddenly  forced  upon  medical 
attention.  Great  numbers  of  questions  await  legal  solution. 
Three  views  held.  The  ethical  and  moral  view.  The  legal  view. 
The  scientific  and  medical  view.  Assumption  of  knowledge  that 
does  not  exist.  Urgency  for  a  clearer  view.  Confusion  noted  in 
two  cases.  Errors  of  medical  men.  It  is  a  question  of  facts  and 
their  meaning.  Was  the  person  an  inebriate?  What  was  his 
mental  condition  at  the  time  of  the  act?  A  study  of  the  answer 
to  these  questions  necessary.  Object  of  the  legal  treatment  of 
inebriates.  Its  failure.  The  reasons  for  it.  The  victims  made 
worse.  The  action  of  alcohol  on  the  brain  explains  th:s.  An  in- 
ebriate witness  dangerous  on  the  witness  stand.  He  is  not  in 
touch  with  the  surroundings.  His  mind  is  confused  and  halting1. 
He  is  a  paralytic.  Automatic  acts  cover  up  this  condition.  His 
disability  seen  when  called  to  do  new  work.  A  mental  waif  sub- 
ject to  the  surroundings.  A  superstition  to  hold  such  a  person 
accountable.  A  question  of  facts  not  theories  or  rulings  of  judges. 

The  jurisprudence  of  inebriety  is  practically  a  new 
territory,  without  boundaries  and  unexplored.  The  ques- 
tion of  the  possible  mental  unsoundness  and  incapacity  of 
the  inebriate  to  reason  normally  and  act  rationally,  is 
asked  with  increasing  frequency  in  a  great  variety  of 
criminal  and  civil  cases,  where  the  question  of  motive  and 
purpose  is  raised. 

The  rapid  advances  in  psychological  study  sustains  the" 
wisdom  and  necessity  for  scientific  inquiry  in  this  field. 
The  medical  profession  has  been  suddenly  called  to  deter- 
mine the  facts  and  their  meanings  concernings  the  acts  of 
an  inebriate  and  give  advice  as  to  his  responsibility  and 
the  means  for  prevention,  and  all  this  without  precedent, 
and  the  medical  theories  are  often  opposed  by  public 
opinion  and  doctors  are  frequently  forced  into  great  dis- 
credit and  confusion. 

As  a  result  of  lack  of  knowledge  many  wild  and  im- 
possible theories  prevail  as  to  what  inebriety  is  and  is  not. 

329 


330  INEBRIETY. 

Statements  are  made  of  moral  and  legal  accountability 
and  responsibility,  that  presuppose  a  degree  of  psycho- 
logical knowledge  which  is  utterly  impossible  in  the  pres- 
ent state  of  the  study,  and  could  only  be  acquired  by  long 
years  of  accumulation  and  comparison  of  facts. 

There  are  to-day  many  persons  awaiting  trial  or  sen- 
tence for  crime  committed  while  under  the  influence  of 
alcohol.  There  are  hundreds  of  business  contracts  dis- 
puted and  contested  in  law  courts,  contracts  made  when 
the  parties  were  intoxicated.  There  are  many  hundreds 
of  wills  whose  validity  is  questioned  for  the  same  reason. 
Also  there  are  innumerable  divorce  suits  where  the  in- 
ebriety of  the  parties  is  the  vital  question  on  which  the 
issue  of  the  case  turns.  Grave  questions  concerning 
pauperism,  idiocy,  criminality,  degeneracy,  all  center  on 
the  exact  knowledge  of  the  meaning  and  extent  of  ine- 
briety. 

These  are  some  of  the  topics  in  this  new  medico-legal 
field  which  must  not  be  ignored  by  the  profession,  or 
be  answered  by  vague  theories  or  dogmatic  assertions. 
Every  year  these  questions  become  more  urgent  and 
the  profession  must  answer  them  on  rational  scientific 
grounds.  Already  the  attempts  to  answer  them,  although 
complicated  with  vague  opinions  and  wild  superstitions 
have  divided  into  three  distinct  theories  or  points  ot  view. 
First,  the  ethical  and  moral  view  which  finds  a  full  ex- 
planation of  inebriety  from  the  teaching  of  Scripture  and 
the  opinions  of  theolo gists  and  moralists.  This  view  af- 
firms that  inebriety  is  a  phase  of  moral  depravity  found 
in  some  measure  in  every  life,  and  one  that  is  susceptible 
of  great  growth  and  development  by  willful  neglect  and 
gratification  of  passion  and  instinct.  Theologically  the 
remedy  is  punishment,  prayer,  conversion  and  the  ap- 
plication of  moral  suasion  and  measures  to  awaken  the 
spiritual  life. 


MEDICO-LEGAL  QUESTIONS  OF  INEBRIETY.         831 

A  crime  committed  while  under  the  influence  of  spirits 
is  a  moral  defect,  a  vice  in  which  the  victim  is  fully 
responsible  and  always  conscious  of  the  nature  and  quality 
of  his  act. 

The  second  is  the  legal  view  which  is  literally  a  mate- 
rialization of  the  moral  theory.  It  assumes  that  inebriety 
is  a  phase  of  savagery  and  inborn  tendency  to  lawlessness, 
and  the  indulgence  of  the  lower  passions,  regardless  of 
law  or  order  or  the  interests  of  others.  The  remedy  for 
this  is  punishment,  suffering,  on  the  principle  that  in- 
dulgence of  the  lower  nature  followed  by  pain  and  suffer- 
ing will  rouse  the  higher  brain  to  take  control  and  throw 
off  the  influence  of  passion  and  instinct. 

If  every  act  of  drinking  was  followed  by  pain  it  would 
be  repelled  and  controlled.  Three  hundred  years  ago 
Lord  Coke,  of  England,  held  that  inebriety  was  always  an 
aggravation  of  any  offense  committed,  and  this  fact 
should  lead  to  greater  punishment  and  never  be  consid- 
ered an  excuse.  This  has  been  the  corner-stone  of  the 
legal  view  of  inebriety  up  to  very  recent  times. 

The  third  theory  is  the  scientific  and  medical  view. 
This  affirms  inebriety  to  be  a  physical  condition,  both 
acquired  and  inherited.  This  physical  condition  is  always 
a  disease  and  an  obscure  or  pronounced  form  of  insanity. 
The  use  of  alcohol  is  a  symptom  and  not  a  cause  in  many 
cases. 

This  theory  asserts  that  degeneration  and  disease  is  the 
basis,  and  the  use  of  alcohol,  by  disturbing  the  brain 
circulation,  causing  congestion  and  paralysis,  brings  on  a 
degree  of  incapacity  which  should  be  realized  and  under- 
stood. The  inebriate  is  always  defective  in  judgment. 
The  nature  and  character  of  his  act  is  abnormal.  His 
power  of  control  is  enfeebled.  Legally  this  theory  re- 
gards the  inebriate  as  diseased  and  incapacitated  to  act 
sanely,  that  his  consciousness  and  control  of  his  acts  are 


332  INEBRIETY. 

enfeebled  and  that  he  should  not  be  regarded  as  competent 
and  sane. 

The  first  two  theories  assume  sanity  and  consciousness 
in  all  cases  of  inebriety,  and  affirm  that  the  only  remedy 
is  punishment  and  strict  accountability  and  suffering,  to 
enforce  it.  The  third  theory  calls  inebriety  a  physical 
condition  requiring  scientific  study  and  physical  and 
psychical  remedies  before  the  proper  treatment  can  be  de- 
termined. 

A  compromise  theory  is  urged,  in  which  inebriety  is 
first  regarded  as  a  vice  or  a  vicious  phase  and  then  later 
a  disease.  At  first  prayer,  pledges  and  punishment  can 
be  used,  and  later  medical  care  and  treatment.  It  is 
difficult  to  understand  the  degree  of  psychological  knowl- 
edge and  ability  necessary  to  discern  where  vice  and 
disease  join,  and  where  to  apply  punishment  and  suffer- 
ing, and  where  to  use  medical  means  and  measures. 

Such  a  theory  defended  on  the  witness  stand  is  a  sad 
reflection  on  the  intelligence  of  the  witness,  particularly 
if  he  is  a  medical  man.  The  pressing  character  of  these 
cases  frequently  brings  these  different  views  into  prom- 
inence, but  only  end  in  confusion  and  injustice  to  all 
concerned. 

Lawyers  and  judges  seek  to  clear  up  this  confusion 
by  assuming  that  the  law  is  absolutely  accurate  and  just 
in  its  basis  and  dictum.  Curiously  enough  many  medical 
men  form  impressions  from  these  dogmatic  assertions  and 
re-echo  them  in  the  court  room.  This  was  very  apparent 
in  a  contested  will  case  where  five  medical  men  testified 
that  a  chronic  inebriate  who  made  a  strange  unusual  will 
was  sane  and  knew  what  he  was  about,  notwithstanding 
the  fact  of  his  continuous  intoxication. 

The  judge  declared  that  he  should  act  on  his  own 
judgment,  and  decided  the  man  was  unsound  and  in- 
capable of  knowing  his  condition. 


MEDICO-LEGAL  QUESTIONS  OF  INEBRIETY.         833 

In  another  case  a  man  set  fire  to  a  church.  Three 
physicians  swore  to  his  sanity ;  notwithstanding  the  fact 
that  he  was  a  chronic  inebriate  and  had  had  delirium 
tremens  recently.  The  jury  decided  otherwise.  In  this 
the  medical  men  sought  to  determine  the  mentality  of  in- 
ebriates, on  previous  theories  of  moral  causation.  This 
was  an  error,  for  irrespective  of  all  theories  such  facts 
can  only  be  determined  from  a  physical  point  of  view. 

In  disputed  cases  it  should  always  be  a  question  of 
facts  and  their  meanings.  Facts  of  heredity,  facts  of 
culture,  training,  development  or  dissolution.  Facts  of 
disease,  injuries,  degenerations,  surroundings,  mentality 
and  so  on  covering  the  entire  history  of  the  case,  physi- 
ological, psychological  and  pathological. 

It  is  only  from  this  standpoint  that  any  clear  concep- 
tion of  inebriety,  and  the  degree  of  responsibility  can  be 
obtained.  The  general  problems  presented  in  all  these 
medico-legal  cases,  are,  first,  Was  the  person  an  inebriate 
or  one  who  drank  spirits  to  excess  at  all  times,  or  at  in- 
tervals? If  this  fact  is  established  beyond  question  then 
the  basis  for  further  studies  into  the  degree  of  sanity  and 
mental  capacity  is  formed  from  which  comparisons  and 
conclusions  can  be  drawn.  A  reasonable  doubt  or  sus- 
picion of  the  sanity  and  mental  capacity  may  be  enter- 
tained. 

Second.  What  was  the  mental  condition  and  the  cir- 
cumstances of  the  person  and  his  surroundings  at  the  time 
of  commission  of  the  act  in  question?  Was  the  act 
reasonable  and  just  in  its  effects,  consequences  and  exe- 
cution? If  not,  the  suspicion  of  insanity  is  strengthened 
and  insanity  and  mental  feebleness  must  be  assumed.  The 
legal  theory  should  be  reversed.  The  sanity  must  be 
proved  and  not  the  insanit}'. 

Third,  the  medical  man  must  be  acquainted  with  the 
facts  and  have  a  reasonable  assurance  of  their  accuracy, 


334  INEBRIETY. 

before  he  can  point  out  conclusions  which  are  naturally 
sustained  by  them.  The  question  is  often  one  of  pre- 
ponderance of  evidence,  which  if  it  indicates  the  ex- 
cessive use  of  spirits  with  irregular  conduct  and  evident 
inability  of  control  is  most  naturally  the  act  of  an  im- 
paired mind  and  a  degree  of  insanity. 

The  efforts  medico-lcgally  are  to  check  and  prevent 
the  illegal  acts  of  inebriates.  Practical  experience  in 
courts  both  in  this  country  and  in  Europe  agree  that 
capital  punishment  for  murder  never  deters  similar  crime. 
Notwithstanding  this  fact,  inebriates  are  tried  as  sane 
and  responsible,  and  executed.  In  the  lower  courts  fines 
and  imprisonment  for  illegal  and  criminal  acts  proves  to 
be  not  only  worthless  as  deterrents,  but  to  increase  the 
very  condition  which  it  aims  to  check.  The  physiological 
reason  which  explains  this  is  that  legal  penalties  make 
no  impression  on  the  intellect  or  higher  judgment  of  the 
man,  because  that  part  of  the  brain  is  palsied  and  so  far 
impaired  as  not  to  recognize  the  danger  of,  or  be  im- 
pressed by,  punishment.  This  will  be  made  clear  from  a 
brief  restatement  of  the  effects  of  alcohol  on  the  brain 
and  body. 

The  increase  of  the  heart's  action  directly  due  to  spirits 
produces  alternate  exhilaration  and  depression  and  this  in- 
terferes with  the  uniform  nutritional  and  functional  ac- 
tivities and  gives  unsteadiness  to  the  development,  and 
direction  of  the  energy  and  course  of  the  brain  with  les- 
sened energy,  and  obscuration  of  the  power  of  discrimi- 
nation. 

The  senses  become  impaired  and  impressions  are  ob- 
scured and  this  darkens  knowledge  and  misleads  judg- 
ment. The  facts  from  the  outer  world  are  imperfectly 
communicated  to  the  brain  and  imperfectly  understood, 
and  the  brain  is  weakened  in  its  power  to  recognize  and 
correct  the  errors. 


MEDICO-LEGAL  QUESTIONS  OF  INEBRIETY.         335 

The  constant  repetition  of  the  convulsive  flow  of  the 
blood  to  the  brain,  rising  and  falling,  not  only  weakens 
perception,  but  judgment  and  discrimination.  Thus,  the 
fine  shadows,  the  uncertainties,  and  the  recognitions  of  the 
value  of  conduct,  acts  and  motives,  escape  the  notice  of 
the  inebriate  because  of  his  impaired  senses  and  judg- 
ment. 

This  he  does  not  recognize.  Often  the  more  spirits  are 
taken,  the  less  doubt  and  more  confidence  he  has  in  his 
judgment  and  ability  to  discern  the  actual  conditions. 
Delusions,  delirium,  egotism,  and  the  idea  of  strength, 
cover  up  the  actual  weakness.  The  false  impressions 
conveyed  to  the  brain  seem  realities  because  of  the  inabil- 
ity to  discriminate.  Thus,  a  man  under  the  influence  of 
spirits  is  a  dangerous  witness  of  facts  observed  in  this 
condition,  because  of  his  impaired  ability  to  see  a  reason 
clearly,  or  a  sequence  and  has  a  delusive  idea  of  the  ac- 
curacy of  his  observations. 

Dr.  Wright  wrote,  that  an  inebriate  witness  testifying 
to  events  and  facts  observed  while  sober  is  more  reliable 
than  a  sober  witness  testifying  to  facts  and  events  ob- 
served while  intoxicated.  We  have  elsewhere  indicated 
the  anaesthetic  condition  of  an  inebriate  manifested  in  the 
voice  and  exaggerations  of  manner,  also  the  sight,  hearing 
and  smell  and  muscular  disturbances.  This  is  literally 
paralysis  extending  all  the  way  from  the  profound  stupor 
of  intoxication  back  to  the  flushed  face  from  the  first 
glass  of  spirits. 

The  irresponsibility  of  persons  in  this  condition  is 
very  evident  in  the  extreme  toxic  stages,  but  the  point 
where  the  impairment  of  the  judgment  and  consciousness 
begins  is  impossible  to  determine.  In  much  the  same  way 
no  one  can  determine  where  twilight  begins,  and  where  it 
ends  in  night.  Hence  the  responsibility  of  the  inebriate 
is  impaired  from  the  first  glass  of  spirits  and  the  first 


336  INEBRIETY. 

paralyzing  effect  of  alcohol  and  its  increase  and  growth 
is  by  stages  differing  widely  in  individuals,  but  always 
present. 

There  can  be  no  question  of  the  inability  of  the 
mind,  and  functional  activities  of  the  brain,  to  take  cog- 
nizance of  facts  and  events  exterior  to  it  when  the  senses 
are  obscured  and  abnormal.  Also  when  the  higher  opera- 
tions of  the  reason  are  impaired  by  faulty  nutrition  and 
toxins.  In  this  case  both  the  sense  impressions  and  their 
recognition  are  lowered  and  enfeebled  and  their  value  lost. 

Alcohol,  of  all  other  drugs,  lowers  the  consciousness 
of  right  and  wrong.  Its  paralyzing  action  obscures  the 
capacity  to  discriminate  on  questions  of  ethics,  in  brief, 
the  morale  of  the  man  is  damaged  first,  and  most  perma- 
nently. The  inebriate,  when  intoxicated,  exhibits  con- 
fused obscure  ideas,  and  false  beliefs  of  morals  and  duties, 
and  all  his  ethical  sensibilities  undergo  a  progressive  de- 
generation. 

The  coarser  automatic  and  organic  operations  of  the 
mind  and  body  may  be  but  little  disturbed,  and  the  prom- 
inence of  the  lower,  more  brutish  and  animal  instincts 
result  simply  from  the  palsy  of  the  higher  co-ordinating 
centers  of  control.  This  is  confirmed  in  so  many  ways 
and  yet  the  impression  has  been  created  that  the  use  of 
alcohol  reveals  the  real  man  which  has  been  covered  up 
before.  In  periodic  drinkers  the  inebriate,  when  sober,  is 
often  amazed  at  the  wild  insane  conduct  during  his  drink 
attack,  but  in  the  continuous  drinker  there  is  no  clear  in- 
terval by  which  he  is  able  to  review  his  previous  thought 
and  conduct. 

The  condition  is  one  of  continuous  and  uniform  paral- 
ysis and  dissolution.  He  may,  before  the  use  of  alcohol, 
have  formed  correct  habits  and  rational  conceptions  of 
life,  which  influence  him  automatically  after  the  use  of 


MEDICO-LEGAL  QUESTIONS  OF  INEBRIETY.         837 

spirits ;  and  thus  he  is  able  to  act  and  appear  along  nor- 
mal and  rational  lines  of  conduct. 

He  may,  as  a  professional  man  or  a  mechanic,  or 
farmer  or  merchant,  follow  an  accustomed  line  of  business 
while  using  spirits  and  appear  to  be  normal  and  sane. 
But  should  any  supreme  crisis  intervene  and  drive  him  out 
of  his  automatic  range  of  life  and  thought,  the  palsied 
state  of  the  brain  will  appear.  Such  men  are  literally 
waifs,  subject  to  the  surroundings  and  changing  condi- 
tions of  life.  The  unexpected  crimes  and  unusual  acts 
and  insane  confusions  of  motive  and  purpose  appearing 
in  persons  who  have  previously  appeared  rational,  but 
have  been  noted  as  spirit  drinkers,  furnish  ample  illustra- 
tions of  this  condition. 

The  conclusion  which  must  be  drawn  from  these  facts 
is  that  all  persons  who  use  spirits  are  more  or  less  un- 
sound, and  have  entered  into  that  penumbral  region  of  ir- 
responsibility and  incompetence,  and  so  are  unable  to  act 
rationally  and  normally ;  also  that  it  is  grave  supersti- 
tion to  assume  that  the  use  of  alcohol  is  not  only  a  volun- 
tary act,  but  that  it  does  not  in  any  way  impair  the 
judgment  and  power  of  control,  and  from  this  theory  to 
insist  on  a  full  measure  of  accountability  where  the  ques- 
tion of  crime  and  illegal  acts  are  raised. 


CHAPTER  XXXII. 
PREMEDITATION  IN  CRIMINAL  INEBRIATES. 


Synopsis. —  Premeditation  considered  proof  of  responsibility. 
Where  reason  and  judgment  are  evident,  sanity  is  assumed  be- 
yond all  question.  In  reality  this  is  not  true.  Many  persons  ex- 
hibit judgment,  premeditation  and  reason  who  are  literally  ma- 
niacs. This  is  sustained  by  a  clinical  history  of  cases.  Drink 
paroxysms,  such  as  in  periodic  cases,  furnish  striking  examples. 
Criminal  instincts  very  often  follow  from  the  paralysis  of  spirits, 
and  disappear  when  spirits  are  banished.  Examples  of  such 
cases.  No  question  of  responsibility  should  be  based  on  these 
symptoms  alone.  The  continuous  drinker  is  very  dangerous  as  a 
criminal,  and  is  always  more  or  less  unconscious  of  the  nature 
and  results  of  his  conduct.  Concealed  delusions  are  very  com- 
mon. The  present  methods  of  punishment  are  destructive  in  many 
instances,  increasing  the  conditions  which  they  are  supposed 
to  correct.  The  use  of  spirits  to  give  courage  to  execute  crime 
is  not  common,  and  always  exhibits  mental  feebleness,  which 
suggests  insanity.  No  apparent  judgment  and  motives  are  safe 
criterions  from  which  to  judge  the  mental  condition  of  the  crim- 
inal. Morbid  impulses,  obsessions,  concealed  delusions  are  all 
more  or  less  common  in  inebriates  who  commit  crime. 


In  the  question  of  the  sanity  of  inebriates  who  are  on 
trial  for  crime,  evidence  of  premeditation  is  considered 
strong  proof  of  the  responsibility  of  the  prisoner.  It  is 
assumed  that  there  must  be  a  degree  of  judgment  where 
purpose  and  motive  are  apparent,  and  this  is  normal. 

If  the  motive  be  of  sufficient  magnitude  and  the  facts 
indicate  distinct  premeditation  and  design,  there  must  be 
some  sanity  in  the  prisoner,  and  the  courts  take  this  view 
of  it.  When  this  reasoning  is  applied  to  inebriates  there 
are  many  exceptions,  and  it  is  very  evident  that  it  is  not 
true  and  can  not  be  used  as  a  general  principle. 

Many  men  obviously  insane  are  capable  of  premedita- 
tion and  often  display  distinct  motives  and  purposes. 
The  ordinary  inebriate,  who  at  the  beginning  has  no  in- 
tention of  carrying  out  any  plan  becomes  obsessed  the 
more  he  drinks  until  he  is  profoundly  intoxicated. 
338 


PREMEDITATION  IN   CRIMINAL  INEBRIATES.        339 

He  does  not  anticipate  the  final  result,  and  is  confi- 
dent that  he  will  always  be  able  to  control  himself  and 
stop  short  of  the  toxic  stage.  In  the  periodic  drinker, 
premeditation  and  motive  has  no  other  purpose  except 
to  provide  for  full  gratification  of  the  drink  impulse. 
That  is  the  central  thought,  to  gratify  this  impulse. 
This  is  so  overwhelming  as  to  destroy  all  other  motives 
and  be  unnatural  and  insane. 

Elsewhere  instances  have  been  noted  of  elaborate  rea- 
soning and  preparation  to  conceal  and  cover  up  the  drink 
attacks  and  provide  for  any  possible  emergency  that 
might  follow.  Such  persons  may  appear  normal  and 
sane  in  other  matters,  but  in  this  they  are  reasoning  ma- 
niacs without  power  of  control  and  possessed  by  an 
impulse  which  dominates  all  other  thought  or  motive. 

A  typical  case  is  that  of  a  banker  of  excellent  judg- 
ment in  all  business  and  social  matters.  He  would  pre- 
pare for  a  drink  paroxysm  for  a  week  in  advance,  and 
display  great  cunning  to  explain  his  absence.  He  would 
send  letters  to  be  mailed  to  his  family  in  the  future,  as 
to  his  location,  giving  explanations  that  were  reasonable, 
so  as  to  prevent  any  unusual  efforts  to  verify  or  discover 
his  real  condition.  Then  he  would  go  on  this  imaginary 
business  and  disappear  for  a  week  or  two.  On  returning 
he  showed  great  activity  to  take  up  charity  and  temper- 
ance work,  and  help  others.  On  several  occasions  these 
attacks  were  broken  up  by  active  treatment  at  home. 

These  periodic  inebriates  show  such  pronounced  mental 
unsoundness  in  these  mysterious  obsessions  that  it  is 
difficult  to  understand  how  they  can  be  considered  respon- 
sible. Should  a  crime  be  committed  during  this  period, 
with  evidence  of  premeditation,  the  courts  will  not  consider 
the  question  of  insanity  other  than  efforts  to  escape  the 
punishment  for  the  crime. 


INEBRIETY. 


The  following  case  brings  out  this  fact  in  a  very  vivid 
light :  A  business  man,  after  a  period  of  moderate  drink- 
ing lasting  several  years,  became  a  periodic  drinker. 
These  periods  were  ushered  in  by  one  or  two  weeks  of 
continuous  drinking  then  several  days  of  profound  in- 
toxication, followed  by  recovery  and  intense  remorse. 

During  the  time  of  continuous  drinking  he  carried  on 
his  business  in  a  sane  and  natural  way,  but  to  his  confi- 
dential clerk  he  displayed  delusions  of  revenge.  He  elab- 
orated the  most  skillful  plans  to  injure  a  rival  in  busi- 
ness by  burning  his  property  and  exploding  dynamite 
under  his  office.  These  plans  were  remarkable  for  motive, 
premeditation,  cunning  and  judgment  of  the  situation 
and  surroundings. 

His  clerk  advised  delay  and  urged  objections,  pointing 
out  the  possibilities  of  failure,  and  in  this  way  prevented 
their  materialization.  After  he  became  fully  intoxicated, 
these  plans  grew  indistinct,  and  finally  faded  away.  He 
regarded  them  as  crazy  notions  and  seemed  ashamed  to 
think  that  he  had  planned  or  talked  about  them. 

The  next  drink  period  the  same  impressions  came  back, 
and  were  more  intense  and  his  plans  were  more  cunning 
and  skillful.  Fearing  that  they  might  be  put  into  execu- 
tion he  was  given  narcotics  and  made  stupid,  and  in  this 
way  the  impulse  was  broken  up.  This  delusion  with  the 
slightest  encouragement  would  have  developed  into  & 
criminal  act,  and  in  the  court  room  no  evidence  of  insanity 
would  have  been  considered. 

The  reasoning  would  have  been  that  the  act  grew  up 
in  his  sane  moments,  and  that  the  use  of  spirits  was 
for  the  purpose  of  giving  him  strength  to  execute  it. 

Another  similar  case  was  that  of  a  moderate  and 
continuous  drinker,  who  planned  a  bank  robbery,  and 
spent  much  time  considering  and  providing  for  any  pos- 
sible failures  which  might  happen.  He  would  visit  dif- 


PREMEDITATION  IN   CRIMINAL   INEBRIATES. 


ferent  banks,  observe  narrowly  the  conditions,  make  notes 
of  the  position  of  the  safe,  counter,  and  the  means  of 
exit.  Then,  by  comparison  with  other  banks,  determine 
that  which  promised  the  least  risk. 

He  made  a  confident  of  his  partner,  who  with  him  con- 
ducted a  grocery  business,  and  gave  him  the  notes  and 
papers  on  which  all  the  plans  and  records  were  stated. 
His  partner  considered  them  as  mere  drunken  whims,  and 
advised  him  to  stop  drinking.  He  would  abstain  for  a 
while  and  then  begin  again. 

Naturally,  he  was  a  very  careful,  sober,  methodical 
man  of  good  judgment  and  was  honest.  The  delusion  was 
very  unusual,  and  foreign  to  his  previous  conduct  and 
thought,  and  yet  he  displayed  most  unusual  skill  in 
calculation  of  possibilities  and  efforts  to  execute  the  crime 
and  conceal  all  traces  of  its  author. 

Here  again  was  the  same  probability  that  with  the 
slightest  encouragement  he  would  have  executed  it.  There 
was  undoubted  insanity,  notwithstanding  the  acute  reason- 
ing, judgment  and  apparent  consciousness  of  the  act. 
To  hold  such  a  man  responsible  and  judge  him  by  other 
standards  of  sanity  would  have  been  fallacious. 

Some  of  these  curious  obsessions  done  under  the  influ- 
ence of  alcoholic  narcotism  show  extraordinary  judg- 
ment and  wisdom.  In  one  instance  a  lawyer  wrote  a  will 
at  a  certain  period  when  drinking.  Later,  under  similar 
circumstances,  another  will  was  executed,  and  so  on  for 
several  years.  Each  will  was  filed  away  with  care  as  to 
all  the  minutiae  and  details.  He  seemed  to  have  no  con- 
sciousness of  having  written  other  wills,  but  clearly  stated 
his  property  and  its  conditions. 

A  man  of  wealth  left  a  large  fortune  to  an  obscure 
school  for  colored  people  in  the  South.  This  was  written 
on  the  eve  of,  or  during,  a  drink  paroxysm.  The  act 
was  a  surprise  to  his  friends,  who  had  never  heard  him 


INEBRIETY. 


express  any  interest  in,  or  knowledge  of,  the  work  of  any 
Southern  school  before. 

In  the  lower  courts  a  great  variety  of  criminal  acts 
by  inebriates  present  degrees  of  reasoning,  premeditation 
and  sanity  that  is  unusual.  In  the  evidence  such  persons 
are  not  stupidly  intoxicated  and  seem  to  be  in  possession 
of  their  normal  reasoning.  The  impression  is  that  spirits 
were  taken  to  lessen  the  punishment  of  the  acts,  but  this 
is  not  confirmed  by  a  careful  study. 

A  number  of  persons  who  have  been  sober,  free  from 
spirits,  living  normal  honest  lives,  commenced  to  drink 
moderately  and  enter  upon  a  criminal  career.  Commonly 
thev  are  sneak  thieves,  appropriating  everything  near 
them,  whether  needed  or  not,  robbing  intoxicated  men, 
snatching  parcels  from  boys  and  women,  then  running 
away,  showing  very  little  cunning  in  the  concealment  or 
effort  to  escape,  but  showing  much  skill  and  boldness  in  the 
acts.  They  are  kleptomaniacs,  and  in  all  probability  this 
is  produced  by  the  paralysis  from  spirits. 

When  such  persons  are  about  to  be  arrested,  or  are 
discovered,  they  not  unfrequently  drink  to  great  excess, 
and  the  motive  is  not  clear.  The  physical  condition  of 
this  is  very  evident  in  the  history  of  a  number  of  such 
persons,  who,  after  serving  a  sentence  in  prison,  recover 
and  come  out,  leading  correct  lives  afterwards. 

Such  persons  have  been  known  to  act  normally  and 
rationally  for  some  time,  but  after  some  sickness  or  dis- 
aster commence  to  drink  and  go  back  to  crime  again. 
In  all  the  criminal  courts,  person  of  this  class  appear 
from  time  to  time  and  are  called  "repeaters"  of  a  high 
grade. 

No  question  of  responsibility  or  mental  feebleness  is 
ever  raised.  Their  crime  and  intoxication  are  considered 
as  vicious  and  culpable,  and  the  courts  never  recognize 
the  moral  palsies,  morbid  impulses  or  concealed  delusions, 


PREMEDITATION    IN    CRIMINAL    INEBRIATES.       343 

and  hence  continue  to  resentence  them,  fixing  their  crim- 
inal status  more  pronounced  than  ever. 

In  this  way  the  effort  to  prevent  crime  by  fines  and 
imprisonments  is  destructive,  and  literally  destroys  the 
sanity  and  normal  mentality  of  such  persons,  training 
them  into  criminal  careers  as  well  as  increasing  their 
mental  degeneration  and  disease. 

A  very  common  theory  prevails  that  crime  is  often 
planned  and  spirits  are  used  to  give  courage  to  execute 
it.  This  is  confirmed  by  criminals  themselves,  but  there 
is  much  doubt  about  its  reality.  A  criminal  by  training 
and  instinct  seldom  takes  spirits  for  the  purpose  of  com- 
mitting a  crime.  Experience  has  shown  that  spirits 
unfits  him  for  the  execution  of  the  act,  and  that  he  needs 
all  the  capacity  and  efficiency  that  he  possesses,  to  be 
successful  and  escape  punishment.  In  reality,  spirits 
confuse  and  weaken  the  mind,  and  prevent  the  judgment 
necessary. 

Low  brutal  crimes  committed  by  persons  under  the 
influence  of  alcohol  rarely  show  any  motive  or  purpose 
other  than  that  of  a  demented  person.  Where  the  use 
of  spirits  has  been  continuous  and  the  brain  is  in  a 
semi-paralyzed  state,  criminal  impulses  may  start  at  any 
time,  and  materialize  into  acts  that  are  clearly  insane. 

The  very  fact  that  the  person  has  been  using  spirits 
continuously  is  the  clearest  possible  evidence  of  unsound- 
ness.  A  theory  prevails  in  the  court  room  that  when  a 
crime  is  committed  by  a  drinking  person  and  the  con- 
sequence and  magnitude  of  the  act  are  partially  realized, 
spirits  are  used  to  conceal  the  motive  and  lessen  the  con- 
sequences. 

It  is  very  doubtful  if  this  can  be  confirmed,  for  in 
reality  the  general  confused  condition  of  the  mind  and 
its  control  is  so  uncertain  that  any  preconcerted  action 
is  unlikely  to  occur.  It  would  seem  in  certain  cases 


INEBRIETY. 


where  persons  drink  to  great  excess  after  the  execution 
of  a  criminal  act  that  there  must  be  some  motive,  but  it 
is  more  likely  to  be  a  morbid  impulse  and  delusional  ob- 
session of  the  same  nature  as  suicide,  and  altogether 
additional  evidence  of  unsoundness  and  irresponsibility. 

In  all  criminal  acts  committed  by  inebriates,  it  is  safe 
to  assume  that  ethical  notions  of  obligations,  duties 
and  consequences  are  greatly  confused  or  lost  altogether. 
No  man  under  the  influence  of  spirits  can  be  normal  and 
have  full  self-control.  Kleptomania,  or  the  desire  for 
appropriating  anything  that  the  mind  may  fancy,  is 
only  another  phase  of  insanity,  particularly  when  as- 
sociated with  the  use  of  spirits.  There  may  be  motive 
in  this,  and  evidence  of  reason  and  judgment,  and  yet 
the  mind  is  obviously  unsound.  We  have  noted  in  previous 
pages  some  striking  examples  of  this. 

A  continuous  drinker  is  more  likely  to  develop  crim- 
inal acts  and  conduct  and  be  the  subject  of  morbid  im- 
pulses, and  concealed  delusions,  and  when  the  fact  of  his 
drinking  is  made  clear,  the  mental  impairment  and  lim- 
ited responsibility  is  of  necessity  present.  The  apparent 
possession  of  judgment  and  sanity  in  inebriates  who  are 
charged  with  crime  should  be  made  the  subject  of  care- 
ful study,  and  no  evidence  of  premeditation  should  be 
regarded  as  sanity  or  a  safe  guide  upon  which  to  base 
degrees  of  responsibility  and  forms  of  punishment. 


CHAPTER  XXXIII. 

DISEASES  AND  NEUROSES  ASSOCIATED  WITH  IN- 
EBRIETY. 

Synopsis. — Both  the  inebriate  and  alcoholic  turn  to  drug's  for 
relief.  Drugs  preceded  the  spirit  taking  and  often  follow  it. 
Very  common  in  the  history.  Drugs  taken  for  other  purposes. 
Examples.  Drugrs  cover  up  the  symptoms,  giving  false  impres- 
sions. Opium  most  commonly  used.  Morphia  very  pleasing  in 
its  effects.  Complicated  symptoms.  Cannabis  Indica,  hyoscyamus 
and  concaine  are  used.  For  symptoms  that  indicate  this  condi- 
tion. Hydrate  of  Chloral  a  common  drug,  combined  with  bromide 
in  proprietary  medicines.  Cocaine  very  fascinating  for  this  pur- 
pose. Some  curious  symptoms  which  follow.  Belladonna  another 
drug  used.  Cannabis  Indica  with  its  peculiar  symptoms.  Chloro- 
form and  paraldahyde,  to  produce  sleep,  also  gelsemine  is  used. 
These  drugs  dangerous.  Where  spirits  are  prohibited,  drug  sales 
are  increased.  Persons  who  recover  without  any  suffering,  to 
be  suspected.  Medico-legal  cases,  in  which  persons  are  using 
drugs  secretly,  to  be  recognized.  Nicotine  poisoning.  Coffee  and 
tea  are  all  to  be  recognized.  Rapid  recovery  of  persons  supposed 
to  be  incurable  point  to  secret  drug  habit.  Examples.  Inebriates 
are  very  susceptible  to  narcotic  drugs.  Their  use  should  be  rec- 
ognized as  dangerous.  Possibility  of  producing  a  new  addiction 
more  dangerous  than  the  first.  A  new  field  to  be  studied. 

The  frequent  references  to  drug  addictions  associated 
with,  and  complicating  inebriety,  will  naturally  call  for 
a  more  detailed  study  of  some  of  the  more  common  forms. 
This  will  enable  the  student  to  discriminate  and  in  many 
ways  to  more  thoroughly  understand  the  conditions  pre- 
ceding the  use  of  spirits,  and  be  better  able  to  treat 
them.  Many  of  these  conditions  have  been  outlined  in 
previous  chapters. 

Both  the  inebriate  and  alcoholic  very  commonly  turn 
for  relief  to  various  narcotic  drugs,  either  in  regular 
prescriptions  or  proprietary  forms.  When  the  effects 
of  these  drugs  are  pleasant,  they  are  used  in  the  place 
of  spirits,  and  not  unfrequently  become  a  distinct  addic- 
tion. This  may  be  for  a  brief  time,  until  some  disturbing 
element  occurs,  or  may  become  more  or  less  permanent. 

345 


346  INEBRIETY. 

In  the  history  of  drug  addicts  a  period  of  alcohol 
taking,  which  has  preceded  the  use  of  drugs,  is  very 
common.  This  fact  in  itself  will  materially  modify  both 
the  diagnosis  and  prognosis,  and  should  be  considered  in 
the  question  of  treatment.  The  history  of  these  cases 
show  that  alcohol  has  been  used  in  various  forms,  particu- 
larly beer  or  wine,  for  a  long  period.  Then  the  patient 
begins  to  suffer  from  some  nutrient  or  nerve  disturbance, 
or  insomnia.  The  family  physician  may  be  called  in 
and  prescribe  some  drug  containing  a  narcotic,  that  is 
particularly  agreeable  and  soothing  in  its  effects,  or  the 
patient  may  resort  to  some  proprietary  drug  and  receive 
the  same  relief.  In  either  case  the  drug  will  be  repeated, 
without  any  thought  of  its  danger,  and  then  finally,  for 
various  reasons,  an  effort  will  be  made  to  discontinue  it, 
which  will  be  unsuccessful. 

This  is  a  very  common  history  of  a  great  many  drug 
addicts,  and  often  in  the  struggle  to  escape  from  the 
use  of  the  drug,  they  will  take  up  alcohol  again,  and 
be  astonished  to  find  a  peculiar  susceptibility  to  it,  which 
did  not  exist  before.  The  drug  addict  becomes  quickly 
intoxicated  from  alcohol,  does  strange  things,  and  then 
finally  comes  back  to  the  drug  from  which  he  is  trying 
to  escape. 

This  period  is  not  unfrequently  without  the  counsel 
or  advice  of  the  physician  and  has  been  an  accidental 
circumstance  of  turning  from  one  thing  to  another  until 
some  drug  is  found  that  would  apparently  diminish  the 
pain  and  discomfort  from  which  he  suffers. 

The  physician  who  is  called  at  this  period,  unless  he 
makes  an  exhaustive  study  of  the  patient,  is  very  likely 
to  make  mistakes  and  fail  to  recognize  the  original  al- 
coholic addiction,  and  the  subsequent  drug  substitutions. 


DISEASES  AND  NEUEOSES.  847 

The  patient  will  very  likely  mislead  him  by  giving  a 
history  of  malaria  or  rheumatism  or  some  disorder  of 
the  past,  which  in  his  mind  has  been  responsible. 

Thus  a  man,  living  in  a  southern  country,  who  drank 
spirits  consecutively  in  so-called  moderation,  may  have 
had  chills  and  fever,  which  to  him  was  the  unmistakable 
evidence  of  malaria,  but  in  reality  it  was  a  toxic  disturb- 
ance, generated  in  the  system  by  alcohol.  Acting  on  his 
own  supposition,  he  may  have  used  large  quantities  of 
quinine,  with  or  without  the  advice  of  his  physician. 
This  with  alcohol  has  still  farther  increased  the  toxaemic 
states,  and  culminated  in  some  specific  disorder,  and  to 
cover  up  and  conceal  this,  narcotics  are  particularly 
valuable. 

Other  cases  occur  where  obstinate  constipation  and 
supposed  congestion  of  the  liver  have  been  treated  for 
a  long  time  with  mercury,  the  alcohol  being  taken  as 
usual.  The  result  is  still  greater  disturbance  and  a 
variety  of  symptoms  which  are  relieved  by  narcotics,  either 
in  the  regular  form  or  in  some  proprietary  drug. 

Other  persons  of  this  class  occupying  responsible  posi- 
tions, using  spirits  for  their  supposed  tonic  and  stimulant 
effects,  have  become  insomniac,  or  have  suffered  from  some 
disturbing  nutrient  symptoms  which  have  resisted  all 
treatment.  Narcotics  prove  most  attractive  and  they 
become  addicts.  Then  they  give  up  the  use  of  alcohol 
and  make  great  efforts  to  escape  from  their  narcotic 
addiction,  but  finally  return  to  the  use  of  both  alcohol 
and  narcotics. 

The  number  of  persons  in  this  condition  is  so  large 
as  to  attract  attention,  and  require  special  study  and 
treatment.  They  are  all  practically  inebriates  and  al- 
coholics who  have  added  to  their  troubles  drug  addictions. 
The  presence  of  extreme  susceptibility  to  the  use  of 
drugs,  particularly  narcotics  and  anaesthetics,  can  often 


348  INEBRIETY. 

be  determined  with  much  certainty,  and  this  fact  is  of 
great  importance  in  the  study  of  the  cases. 

If  the  patients  are  neurotic  by  inheritance  or  from 
neglect  and  exhaustion,  the  conditions  are  graver.  These 
facts  should  always  be  considered  in  the  study  of  cases. 
Quite  a  large  number  of  persons  will  have  a  history  of 
wine  drinking,  beginning  in  college;  then  beer  drinking, 
with  the  result  that  fatigue  and  unusual  exhaustion  follow. 
With  this  there  will  be  associated  gormandizing,  high 
living,  neglect  of  sleep  and  continuous  excitement. 

This  is  the  condition  that  narcotic  drugs  will  effec- 
tually cover  up,  giving  the  impression  of  cure;  and  if 
the  drug  is  resorted  to  repeatedly,  its  use  becomes  an 
addiction.  Opium,  morphia  and  its  other  forms  are  the 
most  common  narcotics  taken,  and  sooner  or  later,  become, 
of  all  drugs,  the  most  attractive  and  fascinating. 

Opium,  in  the  form  of  a  tincture,  is  the  most  agreeable 
of  all  and  many  alcoholics  and  inebriates  boast  of  giving 
up  all  spirits,  but  later  are  found  to  be  dependent  on 
this  drug.  Often  they  are  unaware  of  this.  The  ordinary 
alcoholic  cannot  use  the  ticture  of  opium  long  without 
producing  some  irritant  effects  on  the  stomach,  and  while 
the  narcotism  is  very  pleasing,  the  nausea  and  vomiting 
which  follows  are  distressing.  This  occurs  in  many  cases, 
but  not  in  all. 

For  this,  not  unfrequently,  h}rperdermics  of  morphia 
are  substituted.  The  stomach  regains  its  original  vigor 
and  the  patient  has  simply  changed  the  form  of  the 
drug.  Many  of  the  proprietary  remedies  contain  opium 
and  its  alkaloids.  Hence  it  is  safe  to  assume  that  the 
pleasing  narcotic  action  of  drugs  of  this  class  are  most 
likely  due  to  opium. 

Many  very  interesting  cases  come  under  medical  care 
in  which  the  patient  has  a  variety  of  complex  symptoms 
and  gives  a  history  of  having  taken  some  proprietary 


DISEASES  AND  NEUROSES.  349 

medicines  for  a  long  time,  with  increasing  derangement 
of  the  stomach  and  nutrient  system,  but  with  distinct 
periods  of  rest  and  comfort.  An  early  history  of  al- 
coholic taking  is  not  considered,  and  yet  it  is  the  begin- 
ning and  the  present  addiction  is  only  another  stage  of 
the  same  degeneration. 

The  patient  asserts  that  opium  was  very  irritating  at 
first ;  that  hyperdermics  caused  vomiting  and  nausea,  and 
that  the  drug  which  he  has  taken  was  originally  distress- 
ing, but  finally  it  acted  with  great  satisfaction  and  com- 
fort. In  reality  his  system  has  come  to  tolerate  the 
drug  which  was  nauseating  at  first.  What  he  is  taking 
is  simply  opium  or  its  alkaloids.  The  attempt  to  with- 
draw this  drug  is  followed  by  grave  depressions. 

A  case  of  considerable  interest  was  that  of  a  prominent 
man  who  was  said  to  have  been  very  wild  in  his  early 
life,  meaning  that  he  drank  a  great  deal  of  spirits,  then 
reformed  and  later  became  addicted  to  a  certain  remedy 
which  he  used  in  large  quantities.  An  attempt  was  made 
to  give  up  the  remedy,  but  the  effects  were  so  distress- 
ing that  it  was  resumed  again. 

In  early  life,  when  recovering  from  alcoholic  effects 
morphine  produced  great  depression  and  vomiting,  and 
the  impression  prevailed  in  his  mind  that  this  drug 
could  not  be  opium  or  its  alkaloids,  or  it  would  have 
produced  the  same  effects  which  it  did  years  before. 

He  became  an  invalid,  and  the  remedy  he  was  addicted 
to  was  found  to  be  morphia,  combined  with  Cannabis 
Indica.  The  physicians  considered  it  wise  to  continue 
this  drug  until  his  death,  and  also  permitted  him  to  use 
alcohol  for  the  supposed  purpose  of  keeping  up  his  heart's 
action.  Then  came  a  very  interesting  question  in  the 
contest  over  his  will,  whether  he  was  able  to  sanely  dis- 
pose of  his  property.  A  great  variety  of  medical  testi- 
mony was  introduced,  and  the  will  was  sustained,  but 


350  INEBRIETY. 

it  was  proven  that  his  first  use  of  alcohol  and  later  that 
of  proprietary  drugs  which  contained  opium,  had  evi- 
dently impaired  his  brain,  and  this  with  the  blundering 
effort  to  withdraw  the  drug,  made  him  still  more  irra- 
tional. The  physicians  in  attendance  and  the  experts 
failed  to  realize  the  actual  conditions,  and  the  possibility 
of  help. 

The  diagnosis  is  a  matter  of  considerable  importance. 
When  an  alcoholic  or  an  inebriate  suddenly  stops  all  use 
of  spirits  and  has  no  symptoms  of  irritation  or  depres- 
sion, but  on  the  contrary  rather  boasts  of  his  great 
strength  of  will  and  ability  to  control  himself,  it  may 
safely  be  inferred  that  he  is  taking  some  concealed  drugs 
of  which  morphia  or  other  forms  of  opium  are  the  most 
common. 

Cannabis  Indica,  hyoscyamus,  cocaine  and  other  drugs 
may  be  used  in  the  place  of  spirits,  but  they  cannot  be 
depended  upon  and  are  more  or  less  uncertain.  Morphia 
in  small  doses  is  more  likely  to  be  taken  secretly  for 
long  periods  without  exposure  than  any  other,  and  this 
can  seldom  be  discovered  except  by  experts  and  critical 
examinations. 

Cases  like  the  following  are  to  be  expected.  An  al- 
coholic or  an  inebriate  suddenly  recovers  and  goes  on 
for  a  period  of  years,  claiming  to  be  a  total  abstainer. 
During  this  time  he  will  seldom  call  for  a  physician  and 
then  only  for  some  transient  troubles.  His  manner  and 
air  may  become  secretive  as  he  grows  older.  His  face 
paler,  and  his  eyes  contracted  and  his  sleep  irregular, 
broken  but  profound.  Then  suddenly  he  will  drink 
again,  and  the  degree  of  depression  and  poisoning  which 
follows  will  be  unusual  and  hardly  explainable  by  the 
amount  of  spirits  taken. 

Death  will  follow  either  from  hemorrhage  or  acute 
inflammatory  conditions.  In  reality  the  man  has  been  a 


DISEASES  AND  NEUROSES.  351 

secret  drug  taker  from  the  time  of  giving  up  the  spirits, 
until  they  were  resumed  again.  He  was  able  by  the  use 
of  some  form  of  opium,  to  appear  normal  and  healthy 
and  yet  all  this  time  he  is  becoming  more  and  more 
degenerate.  Then  on  resuming  alcohol  his  real  con- 
dition appeared  which  terminated  in  death. 

It  not  unfrequently  happens  that  an  inebriate,  at  the 
beginning  or  close  of  the  drink  paroxysm,  finds  pleasing 
relief  from  the  action  of  morphia,  either  by  the  needle 
or  by  the  mouth.  This  experience  will  be  repeated  and 
the  time  will  come  when  this  drug  will  be  taken  to  prevent 
the  obsession  of  spirits  from  controlling  him.  This  may 
be  done  secretly,  although  thoughtless  physicians  not 
unfrequently  give  this  drug  at  the  beginning  of  the 
paroxysm,  telling  the  patient  what  they  are  doing  and 
thinking  in  this  way  they  are  breaking  up  the  drink 
craze.  In  reality  they  are  cultivating  another  addiction 
which  is  as  toxic  and  dangerous  as  that  from  alcohol. 

The  efforts  of  quacks  to  cure  such  persons  by  opium 
and  its  compounds  and  then  attempt  to  withdraw  these 
drugs  by  substituting  other  narcotics  is  a  vicious  circle 
from  which  there  is  little  prospect  of  permanent  restora- 
tion. Irregular  and  thoughtless  physicians  lead  spirit 
drinkers  on  a  round  of  different  forms  of  opium  and  other 
narcotics,  and  not  unfrequently  alternating  with  spirits, 
claiming  great  results  from  each  change,  and  yet  leaving 
the  patient  more  and  more  incurable. 

Frequently  some  irregular  physician  will  attempt  to 
cure  an  inebriate  by  continuous  use  of  morphia  or  some 
of  the  alkaloids  of  opium.  Then  suddenly  a  collapse 
follows  and  death,  which  is  called  heart  disease,  but 
has  really  been  toxic  states  overwhelming  the  vital  forces. 

Pneumonia  is  a  very  common  sequela,  is  likely  to  occur 
any  time  and  is  literally  paresis  of  the  pneumogastric 
nerves.  Opium  smoking  is  another  form  of  obtaining 


352  INEBEIETY. 

relief,  and  this  has  perils  peculiar  to  itself.  In  all  this 
there  are  unknown  dangers  and  extreme  liability  to  pro- 
duce a  more  serious  addiction,  than  that  for  which  the 
cure  is  attempted,  and  with  it  all  the  possibility  of  heart 
failure  or  some  unknown  condition  of  collapse  that  is 
given  some  name. 

Instances  are  more  or  less  common  where  the  two 
narcotics  given  both  openly  and  secretly  have  resulted 
fatally.  The  use  of  the  needle,  either  with  morphia  or 
cocaine,  or  other  drugs,  is  both  physically  and  psychically 
dangerous ;  first  because  the  relief  is  very  rapid  and 
pleasing,  second,  it  creates  an  impression  of  perfect  and 
permanent  cure,  the  memory  of  which  remains.  In  reality 
the  derangement  and  depression  is  intensified  and  the 
causes  are  not  removed,  but  other  causes  are  created. 
There  is  no  safety  in  the  attempt  to  treat  the  alcoholic 
or  inebriate  by  narcotics.  In  many  instances  it  is  simply 
changing  the  form  of  addiction  and  disease,  leaving 
the  patient  more  seriously  crippled  than  before. 

Chloral  is  a  drug  that  is  frequently  used  in  inebriety, 
by  itself  or  in  compounds.  In  the  ordinary  inebriate  and 
alcoholic,  where  profound  stupor  and  changing  deliriums 
occur,  there  are  many  reasons  to  believe  that  hydrate 
of  chloral  is  responsible  for  this.  Numerous  persons  have 
been  observed  in  which,  after  the  immediate  effects  of 
drink,  a  peculiar  delirium  appeared.  This  did  not  resem- 
ble the  ordinary  alcoholic  delirium  or  delirium  tremens, 
but  while  being  transient,  was  followed  by  curious  inter- 
vals of  stupor. 

A  person  who  drank  at  intervals  on  public  occasions 
would  the  next  day  have  very  confusing  states  of  delirium 
with  extreme  depression.  This  was  the  subject  of  a  great 
deal  of  comment ;  finally  it  was  found  that  it  was  due 
largely  to  hydrate  of  chloral,  which  was  taken  for  the 
purpose  of  producing  sleep.  It  appears  from  a  number 


DISEASES  AND  NEUROSES.  353 

of  histories  that  chloral  taken  after  the  stupor  of  alcohol 
has  subsided,  will  not  only  produce  a  short  period  of 
sleep,  but  will  leave  the  brain  in  a  confused  delirious 
condition,  which  may  be  checked  temporarily  by  another 
dose.  The  subsequent  symptoms  will  be  increased  and 
more  confused  delirium  will  result. 

Compounds  of  chloral  and  bromide  in  the  form  of 
proprietary  drugs  is  a  frequent  remedy  given  after  the 
use  of  spirits,  and  often  results  in  symptoms  that  are 
more  or  less  confusing.  While  these  associated  disorders 
are  not  very  common  they  should  be  recognized  and 
understood. 

Cocaine  is  another  drug  that  has  a  peculiar  fascination 
in  covering  up  the  effects  from  spirits.  The  narcotism 
from  cocaine  seems  to  fall  on  the  higher  mental  processes 
and  not  only  cover  up  the  irritation,  but  give  an  extreme 
confidence  in  one's  ability  to  overcome  the  physical  disa- 
bilities which  naturally  follow.  The  cocaine  taker  has 
mental  exaltations  which  rise  above  all  remorse  and 
chagrin  and  consciousness  of  loss.  All  discomfort  and 
irritation  passes  away  and  the  relief  and  consciousness 
of  health  is  so  perfect  and  complete  as  to  leave  no  doubt 
in  his  mind. 

The  inebriate  who  after  a  drink  excess  shows  great 
serenity  and  confidence  in  himself  and  has  no  suffering 
is  very  likely  to  be  under  the  influence  of  cocaine.  Not 
unfrequently  there  will  appear  a  certain  garrulity  and 
word  delirium  in  which  the  patient  will  talk  on  all  sub- 
jects and  be  perfectly  happy  and  pleased.  This  suggests 
cocainism  more  than  any  other  drug.  Later  after  this 
period  of  delirium  there  will  be  a  strange  seclusion,  ab- 
stractness  and  period  of  suspicion.  This  also  suggests 
the  same  drug. 

Another  curious  symptom  pointing  to  cocainism  is  in- 
tense literary  activity.  Persons  will  show  an  intense 


354  INEBRIETY. 

desire  to  write  and  compose  all  sorts  of  literary  products. 
This  occurs  in  quite  a  large  number  of  cocaine  addicts. 
An  example  was  that  of  a  village  doctor  who  after  a 
drink  period  would  become  a  very  voluminous  contributor 
to  the  village  paper ;  writing  letters,  poetry,  giving  advice 
on  all  kinds  of  general  and  hygienic  matters.  After  a 
time  this  would  subside  and  then  a  drink  paroxysm  would 
occur  again.  Not  unfrequently  the  alcoholic  or  inebriate 
will  exhibit  very  aggressive  dogmatism,  and  a  delirious 
sort  of  reasoning,  consisting  of  condemnation,  strange 
assertions  and  peculiar  theories.  Occasionally  this  cul- 
minates in  some  overt  act,  which  points  unmistakably  to 
some  other  drugs  and  spirits. 

Belladonna  and  hyoscyamus  are  found  to  be  taken 
very  freely  at  this  period.  The  narcotic  effect  is  in  some 
way  manifest  in  these  peculiar  symptoms.  Cannibis 
Indica  is  another  drug  whose  peculiar  effects  are  often 
very  marked  after  the  first  period  of  narcotism.  Some 
curious  instances  have  occurred  of  inebriates  who  after 
the  use  of  Cannabis  Indica  became  disoriented.  Such 
persons  will  fail  to  recognize  the  street  on  which  they 
live  and  make  mistakes  as  to  the  location  of  their  home 
or  office.  This  will  be  termed  faults  of  memory,  but  in 
reality  it  is  the  poisonous  action  of  this  particular  drug. 

A  very  good  clergyman  who  had  been  a  wine  drinker 
for  years  exhibited  this  fault  to  the  alarm  of  his  friends 
and  physicians.  Finally  it  was  discovered  that  he  was 
taking  Cannabis  Indica  every  night.  The  withdrawal 
of  this  drug  and  the  wine  was  followed  by  recovery. 
Many  persons  suffer  from  insomnia,  both  preceding  and 
following  the  drink  paroxysm,  and  often  while  using 
spirits  continuously.  This  symptom  is  sometimes  very 
distressing  and  is  not  easily  overcome  by  increased  doses 
of  spirits.  Narcotics  are  often  used. 


DISEASES  AND  NEUROSES.  355 

A  few  cases  are  reported  in  which  chloroform  has  been 
given,  and  the  results  are  most  pleasing.  In  this  way 
an  addiction  is  established.  Fortunately  this  cannot  con- 
tinue long,  owing  to  the  peculiar  odor  which  betrays 
the  victim.  Chloroform  addiction  following  the  use  of 
alcohol  is  very  serious.  There  are  profound  degenerations 
of  both  sensory  and  motor  nerves  and  the  withdrawal  of 
chloroform  is  followed  by  obsessions  that  are  frequently 
suicidal.  Many  of  the  suicidal  alcoholics  have  used  chloro- 
form and  the  peculiar  derangement  which  follows  from 
its  use  lowers  the  vital  resources  and  brings  with  it  a 
dread  of  suffering  that  seeks  to  avoid  it  through  death. 

Chloroform  by  inhalation  produces  a  sense  of  relief, 
the  memory  of  which  is  very  fascinating  and  vivid.  Like 
the  effects  of  cocaine  on  the  psychic  centers,  this  impres- 
sion is  never  forgotten,  and  no  matter  what  the  conditions 
are,  the  temptation  to  secure  it  again  is  almost  irresistible. 

Paraldahyde  is  another  drug  used  to  produce  sleep,  but 
its  peculiar  odor  and  taste  makes  it  repellent.  Some 
cases  have  been  reported  of  paraldahyde  addiction,  fol- 
lowing the  use  of  alcohol. 

Gelsemin  frequently  has  pleasing  effects  in  such  cases, 
and  has  been  used  in  proprietary  compounds  for  the 
relief  of  after  symptoms  from  spirit  taking.  Quite  a 
number  of  drugs  containing  combinations  of  chloral,  gel- 
semin  nux-vomica,  atropia  and  opium  are  sold  in  Europe 
to  overcome  the  pain  and  depression  following  from  the 
excessive  use  of  spirits.  They  are  not  very  common  in 
this  country.  The  peculiar  effects  following  from  them 
have  been  noted  in  many  instances.  Coal  tar  derivatives 
and  opium  compounds  are  more  extensively  used  in  this 
country,  together  with  strychnine  and  atropia.  It  should 
always  be  remembered  that  the  effects  of  these  drugs 
are  to  be  considered  from  a  study  of  these  cases,  and 


356  INEBRIETY. 

their  removal  will  reveal  their  special  influence  and  pres- 
ence. 

Many  of  the  obscure  medical  and  surgical  cases  occur- 
ring in  inebriates  have  been  traced  to  specific  drugs  or 
narcotic  prescriptions  used  to  overcome  the  toxsemias. 
Some  investigations  have  indicated  that  in  certain  sections 
of  the  country  where  the  use  of  alcohol  has  been  prohibited, 
the  demand  for  anaesthetics  and  narcotics  is  greatly  in- 
creased. Proprietary  drugs  of  this  class  have  had  in- 
creased sales  in  these  sections.  This  is  a  clear  indica- 
tion of  the  physical  causation  of  alcoholism  and  inebriety, 
beyond  that  of  alcohol. 

While  the  facts  are  not  yet  clear,  it  is  altogether 
probable  that  the  withdrawal  of  alcohol  as  a  beverage 
will  create  a  demand  for  drugs  of  the  anaesthetic  class, 
and  this  will  continue  for  some  time.  The  effects  of  these 
drugs  constitute  a  distinct  phase  or  class  of  symptoms 
which  the  physician  should  be  competent  to  determine. 

Reference  should  be  made  to  medico-legal  cases,  oc- 
curring in  persons  who  have  used  spirits  at  some  pre- 
vious time  and  whose  symptoms  are  so  confusing  as  to 
cause  wide  differences  of  opinions.  Usually  inebriety  or 
alcoholism  has  existed  previously,  and  the  patient  has 
recovered  and  claims  to  be  a  total  abstainer.  While  his 
symptoms  of  ill  health  have  not  attracted  particular  at- 
tention or  question,  he  suddenly  commits  an  overt  act,  or 
docs  some  strange  things  which  is  called  into  legal  ques- 
tion. A  study  of  the  symptoms  shows  considerable  varia- 
tion of  strange  conduct  and  reasoning,  following  the 
withdrawal  of  spirits.  This  can  not  be  called  insanity 
nor  is  it  sane  and  normal  in  many  ways.  Alienists  draw 
different  conclusions  and  usually  assume  that  the  state- 
ment of  the  person  that  he  has  been  a  total  abstainer  is 
true,  but  how  to  account  for  the  irregularities  both  men- 


DISEASES  AND  NEUROSES.  857 

tal  and  physical  which  follow  is  open  to  various  theories 
and  explanations. 

In  all  probability  the  withdrawal  of  alcohol  was  fol- 
lowed by  the  secret  use  of  some  narcotic  drugs  for  a 
long  period  of  time,  and  the  extraordinary  conduct  and 
criminal  acts  were  due  entirely  to  the  degeneration  of  the 
brain,  which  began  with  alcohol  and  was  intensified  by 
drugs  that  were  concealed. 

The  derangement  has  not  reached  the  point  of  being 
open  and  recognizable.  Too  much  emphasis  can  not  be 
placed  on  this  possible  and  probable  fact,  which  is  liable 
to  occur  in  a  great  many  cases  of  criminal  and  insane 
conduct.  Tobacco  when  associated  with  and  following 
the  drink  addiction,  is  a  poison  that  should  be  recog- 
nized. The  withdrawal  of  spirits  is  frequently  followed 
by  the  excessive  use  of  tobacco  and  the  result,  nicotine 
poisoning  and  its  allied  neurosis,  is  a  prominent  factor, 
which  should  not  be  overlooked. 

A  number  of  cases  have  been  noted  where  very  prom- 
inent physical  and  mental  symptoms  have  appeared  after 
the  spirits  were  withdrawn,  that  were  interpreted  as  se- 
rious organic  derangements.  A  later  study  proved  them 
to  be  due  to  nicotine  poisoning. 

Statistics  of  the  cure  of  patients  sent  to  insane  asylums 
as  paretics  and  dements  bring  out  this  fact  very  clearly. 
Hospital  treatment  with  abstinence  of  spirits  and  drugs 
and  with  the  ordinary  limited  measures,  have  restored 
many  persons  that  under  any  other  circumstances  were 
supposed  to  be  incurable. 

A  very  pronounced  case  of  general  paresis  was  per- 
manently restored  in  the  New  York  Hospital  in  the  course 
of  a  few  months.  Both  the  family  physician  and  the 
alienist  had  failed  to  discover  the  use  of  chloral,  cocaine 
and  bromides  which  the  patient  had  taken  for  a  long 
time,  following  an  alcoholic  addiction. 


358  INEBRIETY. 

Hyoscine  is  another  drug  used  to  quiet  the  mental 
disturbances  from  alcoholism  and  inebriety  that  is  very 
likely  to  produce  far  more  serious  symptoms  and  degen- 
erations than  it  is  intended  to  correct.  A  periodic  drinker 
was  given  large  doses  of  this  drug  which  produced  sleep 
and  finally  terminated  in  a  low  form  of  delusion.  He 
was  sent  to  an  insane  asylum  and  recovered  after  a  few 
months.  A  year  later,  he  drank  again,  and  this  time  he 
was  treated  hydropathically.  His  recovery  was  complete. 
This  and  other  instances  suggest  that  hyoscine  on  a 
highly  sensitive  irritant  brain  may  produce  disturbances 
and  mental  conditions  of  most  serious  character.  Like 
chloral  the  pleasing  narcotism  and  sleep  which  follow  may 
develop  congestions  and  irritations  of  a  very  serious 
nature  afterwards.  It  certainly  is  a  very  toxic  drug, 
and  its  peculiar  action  should  be  recognized  in  all  con- 
fused cases. 

It  is  the  opinion  of  many  persons  that  tea  and  coffee 
in  excess  after  the  withdrawal  of  alcohol  are  very  likely 
to  predispose  to  states  of  exhaustion  and  toxaemia,  that 
will  greatly  retard  the  final  recovery.  There  are  many 
reasons  for  believing  that  there  are  certain  persons  sus- 
ceptible to  various  drugs ;  of  which  caffein  and  thein 
should  be  noted  as  complicating  and  encouraging  diseases 
following  the  use  of  spirits. 

The  associated  diseases  from  drug  narcotics  in  alco- 
holics and  inebriates  are  very  numerous  and  complex  and 
we  have  scarcely  indicated  the  principal  ones  and  their 
psychic  influences.  In  reality,  they  constitute  an  un- 
known field,  that  must  be  explored  in  the  future. 

The  great  fact  should  be  remembered  that  the  effects 
of  the  use  of  spirits  in  inebriates  and  alcoholics  prepare 
a  field  for  the  growth,  cultivation  and  development  of  a 
great  variety  of  neuroses  and  psychoses  which  should  be 
studied  and  traced  in  the  questions  of  diagnosis  and 
treatment. 


INDEX. 

PAGE 

Alcoholic   Congress,  International,   Anti 38 

Alcoholism,  the  meaning  of 39 

Alcohol  in  America  very  distinct 48 

The  opinion  of  Dr.  Hughes  on 48 

Alcoholism  caused  by  inhalation 119 

Barometrical  conditions,  causes  of 118 

Saloons  an  active  cause  of 119 

Meat  eating  and  cigarettes,  active  causes  of 124 

Examples  of   126 

Andrieson,  Dr.     Views  on  Pathology 178 

Alcoholic  Amnesia   317 

Degrees  and  claims  of 321 

Some  methods  of  discrimination 320 

Binghamton  Inebriate  Asylum  opened 31 

The  principles  and  purposes  of 31 

Changed  to  insane  asylum 32 

History  of   33 

Books  on  Inebriety  and  their  authors 35 

Beard,  Dr.     Opinions  of 49 

Bowditch,  Dr.     Views  of,  on  Drink  Neurosis 51 

Beer  addiction  results  in  inebriety 122 

And  wine,  the  use  of  in  Europe 122 

Berkley,    Dr.     Opinions    on    the    Pathology 178 

Belladonna   used   after   inebriety 354 

Continuous  inebriates   85 

Two  classes  of 86 

Opinions  of  authorities  on 88 

Symptoms    peculiar    to 89 

Prevalence  in  business  circles 90 

Degeneration  of   91 

Coffee  an  active  cause  of  inebriety 123 

Clinical  examination  and  study  of  inebriety 217 

Charlatan   efforts   of  treatment 296 

Criminal    inebriates    305 

Examples   307 

Can  not  be  regarded  as  sane 311 

Must  be  studies  from  facts 309 

Alcoholic   amnesia   in 317 

359 


360  INDEX. 

Criminal   inebriates — Continued.  PAGE 

Different  classes  of 319 

Variations   in   their  history 324 

Often    moderate    drinkers 325 

Kleptomaniacs    324 

Homicides    321 

Premeditation,  not  a  sign  on  sanity 338 

Inherited    instincts    common 340 

Examples   342 

Irresponsible  as   a  rule    343 

Chloroform  after   inebriety 355 

Cannabis  Indica  after  inebriety 349 

Chloral  used  after  inebriety 352 

Coffee  and  calfein  after  inebriety 358 

Cocaine,  a  fascinating  drug  following  inebriety 353 

Some  peculiar  systems  of 354 

Davis,  Dr.  N.  S 36 

Day,  Dr.  Albert.     His  book 35 

Drinkers,  moderate   57 

Delusional   symptoms    58 

Digestive   disturbances 58 

Delirium 57 

Delirium  Tremens    68 

Word 64 

Dipsomania,  description  of 150 

Day,  Dr.   Albert.     Studies   of   heredity 156 

Diagnosis  of  inebriety 186 

Delirium  associated  with  inebriety 193 

Diagnosis  complicated  in  many  cases   187 

Of    midnight    drinkers 188 

Of  coma   191 

Of  women  who  drink 192 

Examples  of    193 

Opinion  of  authorities  on  189 

Delirium  Tremens   203 

Different  forms  of 204 

Some   general    symptoms   of 204 

Delusions  of    205 

Mortality   from    206 

Pathological  conditions  of 208 

Toxsemic  conditions  of 209 

General  treatment  of 212 

Symptoms  of  other  disorders  associated 215 

Examples    of     214 

Tuberculosis  associated  with   .  .  .260 


INDEX.  361 

PAGE 

Diseases  and  neurosis  associated  with  inebriety 347 

Gelsemium  following  inebriety 355 

Hughes,  Dr.  C.  H.     His  opinions  on  inebriety. . . . .- 48 

Heredity  an  active  cause  of  inebriety 110 

Xoted  among  children 125 

Active   in   the   causation 140 

Historic   references    of 141 

Two   forms   of    141 

General  symptoms  of 142 

Peculiarities  of 144 

Associated    disturbances    with 145 

Examples  of 146 

Chinese  laws  relating  to 153 

Opinions  of  different  authors 154-155 

Hospitals,    different    classes    of 253 

Housing  and  controlling  inebriates 255 

Hospitals  of  the  sanitorium  class 259 

Of  the  future 260 

Of  the  workhouse  class 258 

Under  state  care   261 

For  the  insane.     Treating  inebriates 262 

Under   the    military   plan 267 

Under  private  management  268 

Laws  of   269 

In  England   270 

Leading  in  this  country 271 

History  of  empiricism 297 

Of  different  empiric  efforts 299 

Of  the  success  of  empirics 303 

Of  empiricism  in  England 304 

Hyoscin   after  inebriety 358 

Hydropathic   treatment   of    inebriety 272 

Inebriety    

Antiquity   of    13-17 

In  Babylon    19 

In  Grecian  history,  reference  to 20,  21 

Statements  of  Grecian  philosophers  on 23 

Roman  theories  and  conceptions  of 24 

Views  of  French  physicians  on 25 

Writings  of  Americans  on 25 

J.  E.  Turner's  views  on 26 

First  International   Congress  on 26 


362  INDEX. 

Inebriety — Continued.  PAGE 

Discussions  concerning 28 

Theories  concerning 30 

First  society  for  the  study  of 33 

Journal  of,   its  beginning 33 

English  society,  for  the  study  of 34 

The  meaning  of  the  term 40 

In  America  and  its  peculiarities 47 

Moves  in  psychological  waves 49 

General    symptoms    of 56 

Forms  of  moral  insanity  in 93 

General  causes  of 106 

Special   causes   of    118 

Following   from   shock    114 

Examples  of   115 

A  clinical  examination  of 217 

The  diseases  associated  with 346 

Kerr,  Dr.  Norman.  His  book 35 

Symptoms  divided  into  three  acts 64 

Studies  of  heredity 156 

Kellogg,  Dr.  J.  H 279 

Le  Graine,  Dr.    Studies  of  heredity  by 155 

Lewis,  Dr.  Sevan.     Opinions  of  the  Pathology 181 

Medical  Temperance  Association.     Organized 36 

Name  changed  of 37 

Mason,  Dr.  L.  D.    His  description  of  cases 44 

Magnan,  Dr.     His  division  of  cases 44 

Morell,   Dr.      Paralytics   described   by 44 

Mason,  Dr.  L.  D.     Opinions  of 85 

Moral  insanity  forms  inebriety   83 

Examples  of 86 

Symptoms  of 87 

Types  of  degeneracy  in 88 

Forms  of  palsies  in   100 

MacNicholl,  Dr.     Study  of  defects  in  children 125 

Morell,  Dr.     Studies  of  heredity 153 

Mason,  Dr.  L.  D.    Studies  of  heredity 156 

Studies  of  coma  in  inebriety  by 191 

Medico-Legal  superstitions  concerning  inebriates 317 

Examples  of 320 

Questions   329 

Different  views  held    .  .331 


INDEX.  363 

Medico-Legal  superstitions  concerning  inebriates — Continued.      PAGE 

Errors  of  medical  men 334 

A  new  field  awaiting  study 329 

Automatism  a  common  symptom 336 

Some  superstitions    337 

Morphine  following  inebriety 348 

Medico-Legal  questions,  after  inebriety • 356 

Neurosis  following  inebriety 149 

Associated  degenerations  150 

Dipsomania  one  of  them 151 

Marked  by  fecundity  151 

Examples  of  152 

Table  of  symptoms 153 

Types  of  cases 154 

Stigmata  155 

And  its  heredity 156 

Narcotic  drugs  following  inebriety 346 

Opium  following  inebriety 348 

Periodical  drinkers 40 

Classes  of   41 

Psychopathic  causes  of   42 

Parish,  Dr.    His  description  of  inebriety 42 

Periodic  inebriety,  its  symptomology 70 

Premonitory  symptoms    73 

Periodic    inebriates,    different   classes    of 74 

Psychical  symptoms    75 

Periodical  drinkers,  examples  of 78 

Psychoses   of   inebriety    128 

Forms  of   129 

Symptoms    of     130 

Examples  of    131 

Traumas,  an  active  cause  of 133 

Occupations    active   causes    of 136 

Diagnosis   of,    important 137 

Parish,  Dr.     Studies  of  heredity 156 

Psychic   inebriety   traceable   to   heredity 158 

Symptoms    and   examples    of 159 

Pathological   states    166 

Impressions  and  obsessions  of 166 

Pathology  of  inebriety    176 

Modern  views  of   177 

Heart  and  blood  vessels,  effects  on 180 


364«  INDEX. 

PAGE 

Pathology,    opinion    of    authorities    on 178-179 

Palsies,  a  common  symptom 183 

Pathology,  structural    184 

Pathology,    functional     185 

Prognosis  of  inebriety    185 

General  symptoms  to  be  observed 186 

Patent  medicines  and  their  influence 197 

Predisposition  a  large  factor  in  the  prognosis 198 

Pledges  and  prayers  among  the  remedies 196 

Prognosis  depends  on  toxaemia  and  traumas 200 

Prognosis  good   in  most  cases 202 

Prognosis    complicated     199 

Prognosis,  examples  of 198 

Premeditation  in  criminal  inebriates 338 

Examples   340 

Inability  to  reason  wisely 341 

Impulsive,  transient  and  uncertain 343 

Paraldahyde  following   inebriety 355 

Proprietary  drugs  common  after  inebriety , 346 

Pneumonia  frequent  termination 351 

Symptoms  of  inebriety 217 

Changes  first  noticed  218 

Disturbances  of  the  stomach 219 

Mental  disturbances  220 

Rapid  changes  221 

Careful  studies  necessary 222 

Suspicious  egoism  223 

Psychical  changes  common  224 

Shepard,  Dr.  C.  H 272 

Turner,  Dr.  J.  B.,  founder  of  the  asylum 30 

The  work  and  history  of 32 

Treatment,  general  principles  of 223 

Special  questions  to  be  considered  in  the 226 

Conditions  to  be  avoided 225 

Remedies  of  general  value 226 

Complex  conditions  to  be  considered 229 

Danger  of  depending  on  drugs 230 

Home  and  office  231 

Acute  conditions  to  be  overcome 232 

Toxic  conditions  to  be  considered 234 

Temperate    use    of   spirits    so-called 236 

Treatment,  examples  of  cure 242 

Some  drugs  most  practical 244 


INDEX.  365 

Treatment,  examples  of  cure — Continued.  PAGE 

Empiric  efforts  248 

Institutional  249 

Antiquity  of  249 

Hospital  methods  and  means 251 

By  hot  air  272 

Radiant  light  baths 273 

Vibration,  electric  currents  274 

Treatment  by  hydropathic  means 278 

The  effects  of 281 

Treatment,  the  psychical  effects 282 

Treatment  by  mental  suggestion 286 

By  gold  cures  287 

Details  of  by  suggestion 290 

Examples  of  cure 294 

By  colored  lights 295 

Washingtonian  movement  30 

Home,  the  beginning  of 30 

Wright,  Dr.  T.  L.,  book  on  inebriaism 35 

Conclusions  from  studies 112 

Studies  of  heredity 155 

Woodhead,  Dr.     Conclusions  on  the  Pathology .180 


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